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Severs Disease The Truth

Overview

Sever?s disease is similar to Osgood-Schlatter disease of the knee in that they both involve a partial detachment or tearing of the tendon from the bone. The difference is location: Osgood-Schlatter occurs at the knee, and Sever?s occurs at the ankle. In Sever?s disease, which usually occurs in children from the ages of 8 to 14, the Achilles tendon begins to tear away from its insertion into the calcaneus or heel bone. This injury can be very painful and affect highly active to somewhat inactive children. Symptoms include pain that increases with activity, localized pain in the back of the foot, tenderness to the touch, and swelling. Treatment includes rest, ice, compression, elevation, and nonsteroidal anti-inflammatory medication as necessary.

Causes

During the growth spurt of early puberty, the heel bone (also called the calcaneus) sometimes grows faster than the leg muscles and tendons. This can cause the muscles and tendons to become very tight and overstretched, making the heel less flexible and putting pressure on the growth plate. The Achilles tendon (also called the heel cord) is the strongest tendon that attaches to the growth plate in the heel. Over time, repeated stress (force or pressure) on the already tight Achilles tendon damages the growth plate, causing the swelling, tenderness, and pain of Sever's disease. Such stress commonly results from physical activities and sports that involve running and jumping, especially those that take place on hard surfaces, such as track, basketball, soccer, and gymnastics.

Symptoms

The most prominent symptom of Sever's disease is heel pain which is usually aggravated by physical activity such as walking, running or jumping. The pain is localised to the posterior and plantar side of the heel over the calcaneal apophysis. Sometimes, the pain may be so severe that it may cause limping and interfere with physical performance in sports. External appearance of the heel is almost always normal, and signs of local disease such as edema, erythema (redness) are absent. The main diagnostic tool is pain on medial- lateral compression of the calcaneus in the area of growth plate, so called squeeze test. Foot radiographs are usually normal. Therefore the diagnosis of Sever's disease is primarily clinical.

Diagnosis

This can include physical examination and x-ray evaluation. X-rays may show some increased density or sclerosis of the apophysis (island of bone on the back of the heel). This problem may be on one side or bilateral.

Non Surgical Treatment

Traditional treatment involved simply telling children that they can?t play sport for a year. This is not popular for children or parents and abstaining from sport leads to other problems when wanting to return. Treatments focus on improving foot and lower limb function with footwear selection, heel raises, calf stretching, prescription orthoses, run technique training and training modifications. This results in a reduced load through the growth plate and the child can perform more activity before the growth plate becomes inflamed. Rest will always reduce the Sever?s disease symptoms, however this is always the last option.

Recovery

In some cases, children will simply outgrow Sever's Disease when they reach a certain age, but this does not mean that symptoms should be ignored. If children express that they are in pain, this should always be taken seriously by their parents or guardians. Heel pain may be a sign of Sever's Disease and this condition should not be left untreated, due to the damage it can cause to the growing heel bones. Scheduling a doctor's appointment is always the first step to take in gaining a diagnosis of symptoms and speedy help for the child.

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