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Physical Rehabilitation And Severs Disease
Overview


Sever?s disease, also known as calcaneal apophysitis, is an inflammation of the heel?s growth plate. It is commonly seen in active children between the ages of 8 and 15 years. These children present with pain when walking, running and jumping. Observable inflammation may or may not be present and parents may often notice their child limping or favouring a limb during or after sports.


Causes


The cause of Sever's disease is not entirely clear. It is most likely due to overuse or repeated minor trauma that happens in a lot of sporting activities - the cartilage join between the two parts of the bone can not take all the shear stress of the activities. Some children seem to be just more prone to it for an unknown reason - combine this with sport, especially if its on a hard surface and the risk of getting it increases. It can be almost epidemic at the start of some sports seasons, especially winter. At the start of winter, the grounds are often harder, but soften later. Children who are heavier are also at greater risk for developing calcaneal apophysitis.


Symptoms


Sever?s disease is a clinical diagnosis based on the youth?s presenting symptoms, rather than on diagnostic tests. While x-rays may be ordered in the process of diagnosing the disease, they are used primarily to rule out bone fractures or other bone abnormalities, rather than to confirm the disease. Common Characteristics of Sever?s Disease include Posterior inferior heel pain. Pain is usually absent when waking in the morning. Increased pain with weight bearing, running, or jumping (or activity-related pain). Area often feels stiff or inflexible. Youth may limp at the end of physical activity. Tenderness at the insertion of the tendons. Limited ankle dorsiflexion range that is secondary to tightness of the Achilles tendon. Activity or sport practices on hard surfaces can also contribute to pain, as well as poor quality shoes, worn out shoes, or the wrong shoes for the sport. Typically, the pain from this disease gradually resolves with rest.


Diagnosis


Sever condition is diagnosed by detecting the characteristic symptoms and signs above in the older children, particularly boys between 8 and 15 years of age. Sometimes X-ray testing can be helpful as it can occasionally demonstrate irregularity of the calcaneus bone at the point where the Achilles tendon attaches.


Non Surgical Treatment


Reduce inflammation:


Ice: For at least 20 minutes after activity or when pain increases.


Nonsteroidal anti-inflammatory drugs:(NSAIDs) may also help. Stretch the calf. Increase calf flexibility by doing calf stretches for 30 to 45 seconds several times per day.


Protect the heel: The shoe may need to be modified to provide the proper heel lift or arch support.


Select a shoe with good arch support and heel lift if possible. Try heel lifts or heel cups in sports shoes, especially cleats. Try arch support in cleats if flat feet contribute to the problem.


Take it one step at a time:. Gradually resume running and impact activities as symptoms allow. Sever?s disease usually goes away when the growth plate (apophysis) matures, which should be by age 12 to 13 years in females and 13 to 14 years in males.