By: Michael Daigle, Canadian Certified Pedorthist

As a Canadian Pedorthist I see many young athletes in clinic who complain of heel pain. Most of the time it turns out to be Sever’s Disease which is eponymous with a Dr. Sever who identified the condition just over a hundred years ago.

In the Pedorthic community we refer to it as Sever’s syndrome. Parents cringe when they hear the word disease. It is not a virus, nor is it permanent and does not require surgery. Yet it is accountable for most of the heel pain seen in early teenagers who are involved with a running or jumping sport, like soccer, basketball or baseball. It can be very painful. It is more typical to present only on one side but not uncommon to be bilateral.

Usually the patient notes pain in the posterior heel inferior to the insertion of the calcaneal tendon, which is the Achilles tendon, the largest and strongest tendon in the human body. There is seldom any bruising or swelling at the site. What is there is a growth plate, cartilage really, which isn’t yet fused to the calcaneus; ergo it is a weak area. It is known as the apophysis so we refer to this as calcaneal apophysitis, and is one of the common osteochondrosis affecting growth plates in the body. Upon examination there is pain to squeeze the heel in the cup of your hand or to press on the area with your finger. Also pain is noted when you dorsiflex (point your toes to your nose) the ankle because of the increased ‘pull’ from the Achilles. If the calf muscles are tight then there is more tension in the heel. Typically we saw more boys than girls between ages 8 and 15, but onset can be younger in girls just before puberty. With soccer and softball being more popular with girls nowadays, we see as many girls as boys.

There are biomechanical reasons that predispose an active teenager to this syndrome. A particularly high arch with less than normal ankle pick up (dorsiflexion) or a flat arch type with too much hindfoot (subtalar joint) pronation will generate heel pain when running. Good footwear with a strong heel counter like runners will help but usually they will be wearing cleats during a game, and cleats have not evolved much over the past decades.

One has to be sure that there isn’t a calcaneal fracture so in our history taking we explore onset to determine if there was trauma that may have led to a fracture. Maybe your family doctor will decide to order an x-ray to see how mature the growth plate is. Sometimes a simple ankle sprain will eventually lead to this heel pain.
I recommend a team approach to help these young athletes. Pedorthic management might include a custom orthotic device which will control hyper pronation and decrease the stress on the Achilles insertion. Sometimes a simple heel raise of 4-6mm is enough to relieve the effects. Physiotherapy is suggested for a patient with tight musculature; your therapist will show the teenager some home exercises to alleviate the pain.

Questions?
Call: Mike at Maritime Foothold Orthotics 902.434.3668
Email: mfo@ns.sympatico.ca