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  • Dori Nissenson

Does Your Child Have Growing Pains?

Growing Pains Are Real!!!

With the start of the nicer weather and spring sports, my practice has been full of kids diagnosed with Sever’s Disease. Sever’s is not actually a disease but it is a heel injury that occurs during or after a growth spurt in children and can cause serious pain to your child.

Because I am seeing so many kids with Sever’s, I felt compelled write this newsletter in order to explain what Sever's is, how it can be treated and how your child, with your help, can prevent the recurrence of Sever’s Disease.

What Causes Sever's Disease?

Your child’s heel bone is one of the first body parts to reach full adult size. During a growth spurt, the heel bone grows superfast. The muscles, tendons, and ligaments in the leg can’t keep up with this growth. These structures are then stretched too tight causing the muscles, tendons and ligaments to pull at the heel bone resulting in pain and swelling. What complicates things even more is that, in these times, our children are very active, playing sports all year round and often the same sport all year round. Unfortunately, these kids never get a break and due to this intense level of activity, they further strain the already overstretched tendons. Children that play a sport that involves a lot of running and jumping on hard surfaces such as soccer, basketball and gymnastics are particularly prone to developing Sever’s Disease.

How Does Sever's Disease Affect Your Child?

Sever’s Disease is more common in boys, although I have more young girls with Sever’s in my practice at this time The development of Sever’s coincides with their growth spurts. Girls typically have a growth spurt earlier than boys and Sever’s often sets in between 8 and 13. Boys usually experience a growth spurt later and typically get Sever’s between 10 and 15. I have also noticed that Sever’s Disease occurs more in children with a knock-knee posture in their legs and severely flat feet.

The symptoms of Sever’s include:

1. Pain and swelling or redness in one or both heels 2. Tenderness or tightness in the back of the heel that feels worse when the area is squeezed 3. Heel pain that gets worse after running or jumping and feels better after rest. The pain may be more intense in the beginning of a sport season and may be exacerbated by wearing hard shoes like soccer cleats

4. Trouble walking 5. Limping with walking or running or avoiding putting weight on the heel

How Is Sever's Disease Treated?

To all my fellow parents out there, don’t worry!!! Sever’s does not cause any long-term foot problems and symptoms do go away once a child is done with his or her growth spurt.

However, until then, it is imperative to address the issue with physical therapy to minimize your child’s discomfort and allow them to return to their sport faster.

Treatment Is Often The Following: Medication: Your doctor may recommend a non-steroidal anti-inflammatory such as ibuprofen or naproxen. Physical Therapy: The physical therapist will do a thorough evaluation and create a treatment plan including the following:

a. Soft tissue mobilization: The physical therapist will perform manual work on the tight muscles and tendons and other connective tissues to improve the mobility of the muscles that attach into the heel bone. b. Stretching: The physical therapist will perform stretches to lengthen the tight musculature that attach into the heel bone and will instruct your child in doing them at home. c. Taping: The physical therapist will tape the painful heel to minimize the stress on the heel bone. d. Strengthening: The physical therapist will strengthen weaked musculature in your child's feet and ankles to minimize the stress on your heel bone. e. Shoe wear recommendations: The physical therapist will recommend supportive shoes that will minimize stress on the heel bone. f. Orthotic fabrication: The physical therapist will fabricate either temporary or permanent orthotics to help better support your child’s foot in the shoe, minimizing stress to the whole foot and ankle.

What Can You Do At Home To Treat Your Child?

The following may speed up recovery from Sever’s and prevent the occurrence or recurrence of the issue:

1. Encourage your child to rest when not actively participating in his or her sport. This means when he or she is not “on the field” he or she should be resting. 2. Encourage your child to stretch before or after playing sports, as well as when he or she is not playing. Stretching should become a daily part of your child’s routine. 3. Only allow your child to wear the most supportive shoes when he or she is at school all day and is spending a lot of time on his or her feet. 4. Try to avoid a lot of barefoot walking on hard surfaces. Encourage your child to wear shoes most of the time but make sure the part of the shoe that comes up around the heel is soft (unlike the soccer cleat). 5. If your child is having physical therapy, encourage him or her to be 100% compliant with doing the recommended stretches and exercises daily. 6. If your child’s physical therapist has made your child shoe inserts or orthotics, make sure that he or she is wearing them every day. 7. If your child complains of heel pain, begint stretching and icing the affected area(s) immediately. If your child starts complaining of heel pain, start stretching and icing immediately.

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