Sever's disease, also known as calcaneal apophysitis, is a common condition in children and adolescents characterized by inflammation of the growth plate in the heel bone (calcaneus). It typically occurs during periods of rapid growth, especially in active children involved in sports or activities that involve repetitive impact on the heels. Understanding Sever's apophysitis, its symptoms, diagnosis, and treatment options is essential for parents, caregivers, and healthcare providers to manage the condition effectively and ensure the well-being of young athletes.

Sever's disease is a painful inflammation of the growth plate in the heel bone, where the Achilles tendon attaches. As children grow, the growth plate is susceptible to injury and inflammation, particularly during periods of increased physical activity or sports participation. While Sever's apophysitis is not a true "disease," it can cause significant discomfort and affect a child's ability to participate in sports and other activities.

Sever's apophysitis typically occurs in children between the ages of 8 and 14, during periods of rapid growth known as growth spurts. Boys are more commonly affected than girls. The condition is often associated with sports that involve running, jumping, or sudden changes in direction, such as soccer, basketball, gymnastics, or track and field. Overuse or repetitive stress on the heel bone and growth plate can lead to inflammation and pain.

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Symptoms

Common symptoms of Sever's apophysitis include:

1. Heel Pain: Pain and tenderness in the back or bottom of the heel, especially during or after physical activity.
2. Limping: Children may limp or walk on their toes to avoid putting pressure on the affected heel.
3. Stiffness: Stiffness or tightness in the heel or calf muscles, particularly in the morning or after periods of rest.
4. Swelling: Swelling or redness in the heel area may be present, although this is less common.

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Diagnosis

During the exam, Dr. Kamel will assess the child's medical history, symptoms, and perform a thorough examination of the feet and ankles. X-rays may be ordered to rule out other potential causes of heel pain, such as fractures or structural abnormalities. In Sever's apophysitis, X-rays may reveal widening or irregularities in the growth plate at the back of the heel bone.

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Treatment

Treatment for Sever's apophysitis focuses on relieving pain and inflammation and promoting healing of the affected growth plate. Common treatment options include:

1. Rest: Limiting or avoiding activities that exacerbate symptoms, such as running or jumping, allows the inflamed growth plate to heal. Rest does not necessarily mean complete immobilization but rather avoiding high-impact activities that aggravate the condition.
2. Ice Therapy: Applying ice to the affected heel for 15-20 minutes several times a day can help reduce pain and inflammation. It's essential to use a cloth or towel to protect the skin from ice burns.
3. Stretching Exercises: Gentle stretching exercises for the calf muscles and Achilles tendon can help relieve tension and improve flexibility. Stretching should be done regularly but without causing pain.
4. Orthotic Devices: Shoe inserts or orthotic devices that provide cushioning and support can help alleviate pressure on the heel and promote proper foot mechanics during walking and sports activities.
5. Heel Cups or Pads: Gel heel cups or pads placed inside the child's shoes can help cushion the heel and reduce discomfort during weight-bearing activities.
6. Medication: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, may be recommended to alleviate pain and reduce inflammation. However, these medications should be used under the guidance of a healthcare provider and not given to children without proper supervision.

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Recovery

The recovery time for Sever's apophysitis varies depending on the severity of symptoms and how well the child responds to treatment. In many cases, symptoms improve with conservative measures within a few weeks to a few months. However, it's essential to follow Dr. Kamel’s recommendations regarding rest, activity modification, and any prescribed therapies or devices to ensure optimal recovery.

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General Considerations

1. Gradual Return to Activity: Once symptoms improve, children can gradually return to their usual activities and sports. It's crucial to increase activity levels slowly and avoid overdoing it to prevent a recurrence of symptoms.
2. Proper Footwear: Encourage children to wear supportive footwear with adequate cushioning and arch support, especially during sports and physical activities. Avoiding shoes with flat soles or inadequate cushioning can help reduce stress on the heels.
3. Monitoring Growth: Since Sever's disease often occurs during periods of rapid growth, regular monitoring of the child's foot development and symptoms is essential. Parents and caregivers should be vigilant for any signs of persistent or worsening heel pain and seek prompt medical attention if necessary.