Severs disease is foot pain and/or ankle pain as a result of inflammation of the growth plate of the heel bone in children. In the initial stages of the condition most children displaying signs of Severs disease will tend to hobble or limp off the football field, soccer pitch, basketball court or netball court. Kids will complain of sore heels near the end of activity. This condition most commonly affects children between the ages of 8 to 14 years. This type of condition commonly occurs in those kids who are very active with sport.
The cause of the pain in Severs disease is thought to be the tractional forces applied to the growth plate of the heel bone, Achilles tendon and the plantar fascia. This tractional force by the Achilles tendon and the plantar fascia on the growth plate is often aggravated by tight calf muscles and excessively pronated feet (i.e. feet that “roll in” too far). The good news is that this heel pain in children is very simple to treat and children usually respond very quickly to treatment once treatment of Severs disease commences.
Treatment
When this condition affects both feet, often the diagnosis can be made clinically. If only one foot is affected then x-rays should always be taken of both feet if your child fails to respond to what is considered normal treatment for Severs disease. This is to ensure serious problems such as bone infection or bone tumours are not overlooked. Even in cases where both feet have been affected, x-rays or MRI scans should be carried out if a child is failing to respond to conservative treatment.
Treatment of Severs disease usually involves a combination of ice therapy, activity review and / or modification, review of training surfaces, exercises, footwear review and orthotic inserts where foot function is causing excessive traction on the heel growth plate.
Treatment of Severs disease does NOT require surgery. This foot condition responds very well to conservative treatment within a matter of weeks. If your child suffers from heel pain, get them checked out especially when only one foot is affected.
Osgood-Schlatter disease causes pain in the front of the knee. It is commonly seen in boys and girls between the ages of 9-16. It features a painful lump just below the knee, this is because of inflammation of the patellar ligament at the tibial tuberosity. The pain usually occurs during physical activity such as running, jumping, squatting and going up and down stairs.
Around 75% of cases affect boys and occurs in up to 20% of sporty children compared to 4% of a group of all activity levels. In a quarter of cases, both knees are affected and it is more likely to occur around periods of rapid growth. As the condition is due to irritation and damage of the growth plate, it can only occur while the growth plate is present, up to the age of 16 years approximately.
Mechanical factors play a big role in Osgood–Schlatter’s disease. When the feet are in ‘perfect’ alignment, the quadriceps muscles, patella tendon, patella and tibial tuberosity are all in a line. Any force created by using the thigh muscles transmits to the tuberosity in a direct, front-on direction. A pronated foot will increase the quadriceps angle in a similar way that a knock kneed position would. The change in the angle of pull can leave the trochanter more vulnerable from an angled pulling force.
Ignoring symptoms or adopting a ‘no pain, no gain’ attitude is likely to cause further damage and prolong recovery in patients with Osgood Schlatters disease. Immediate, appropriate treatment in patients with this condition is essential to ensure a speedy recovery.
Some of the factors which may contribute to the development of Osgood Schlatters disease include:
A sudden increase in training or sporting activity
Inappropriate training
Recent growth spurts
Inappropriate footwear
Muscle tightness or weakness (particularly the quadriceps)
Joint stiffness
Poor lower limb biomechanics
Poor foot posture
Treatment techniques the Podiatrist may use include:
RICE (Rest, Ice, Compression, and Elevation)
Orthotics-The Podiatrist may discuss the use of foot orthotics as part of a treatment plan. This is especially important if there are biomechanical factors that exacerbate the tension on the patella tendon. This will help support the foot and reduce the effect of biomechanical abnormalities such as an excessively pronated foot.
Stretching—Advice on stretching the quadriceps & hamstrings.
Recommence sport in a month or so
Training changes—depending on your activities the podiatrist may recommend modifications to a training regime. Return to activity should be supervised by a qualified person such as a podiatrist or experienced adolescent coach.
The success rate of treatment is largely dictated by patient compliance.
