In this episode, Dr. Mikkel Jarman discusses how to determine whether a child's heel pain is the result of Sever's disease. Sever's is a condition caused by a growth spurt in which the heel bone grows at a faster rate than the muscles and tendons surrounding it. While it is painful, it is usually temporary and mainly affects children ages seven to fourteen years old. Heel pain will worsen with physical ground and pound activities such as dance and gymnastics, soccer, football, baseball. Sever's disease treatments can include: elevating the leg and applying ice, specific leg and foot stretches, and sometimes custom orthotic shoe inserts.
[00:00] - Dr. Mikkel Jarman
Hello, I'm Dr. Mikkel Jarman here with Pediatric Foot & Ankle, and today I want to discuss the condition of Sever's, otherwise known as calcaneal apophysitis. This is part one of a series of videos on this topic. This condition is diagnosed easily in the office by many health care providers by simply grasping your child's heel and squeezing firmly on the sides. This will place pressure across the growth plate and in turn immediately result in discomfort for the child. Sever's commonly occurs in are physically active children between the ages of seven and 14.
[00:29] - Dr. Mikkel Jarman
Pain will worsen with physical ground and pound activities such as dance and gymnastics, soccer, football, baseball. It's all caused by overuse. Sever's doesn't discriminate with foot type, as is equally seen in flat feet, high arch feet and normal foot types. It can be very debilitating for children. It demotivates them from wanting to do sports, be active and play. On x ray, the growth plate center will appear between the ages of four and six and will not close down until around 14 to 15 years of age.
[01:01] - Dr. Mikkel Jarman
We take digital X-rays here in the office to evaluate the appearance of the growth plate. In some cases, symptomatic children will often show fissuring or a series of small fragments at the back of this apophysis. Sever's is the result of two forces crossing this growth plate in the heel bone, a push and a pull force. As the child walks, runs and plays, their heels dive into the ground and the ground pushes back, applying direct pressure across this plate.
[01:31] - Dr. Mikkel Jarman
The Achilles tendon will fire to push the child forward onto their toes. This tendon attaches directly to the back of the apophysis, putting an upward traction on the unossified growth plate. This repeated push pull stress on the growth plate causes an intense inflammation that leads to pain at the sight causing the condition of Sever's. Some of the signs and symptoms are fairly universal, with heel pain in one or both of the heels that will often come and go. Pain that gets worse with activities, especially heavy ground and pound activities. Your child may be limping or walking on their toes or the sides of their feet to avoid putting pressure on the heels.
[02:14] - Dr. Mikkel Jarman
Pain intensifies with this walking, running or jumping. Again, pain originating from the back of their heels. Sever's is eradicated by neutralizing these two forces that are violating this growth plate. Here at Pediatric Foot & Ankle, we utilize the Mikki device. It is a specific orthotic device used for treating Severs. I treat many painful conditions and deformities in the feet with custom orthotic devices and very few respond as well as Sever's does. If you'd like to learn more about the Mikki device in the treatment of Sever's, please see my other videos and call our office today to make an appointment to have your child evaluated.
[02:56] - Dr. Mikkel Jarman
I'm Dr. Mikkel Jarman. Thanks for watching.