Sever's disease and osteopathy

Sever's disease was described by James Warren Sever in 1912. It is a growth osteochondrosis that affects the secondary ossification nucleus of the calcaneus (the heel bone).

This growth pathology mainly affects young boys between the ages of 8 and 15, and particularly sports children.

Sever's disease affects the heel, Osgood Schlatter's disease affects the knee, but the pathophysiology mechanism is the same.

Sever's disease is probably related to:

• Too much traction of the achilles tendon on its distal insertion, namely the calcaneus 
• Too high a frequency and intensity of impact on the heel bone
• A postural imbalance, such as a foot with a collapsed medial arch, which would generate poor angulation of the Achilles tendon and therefore too much traction at its insertions.

The problem lies in the fact that in children the heel area, among other things, is not completely ossified and this will stimulate the ossification nucleus of the calcaneus and can generate pain.

When we grow, we grow one leg after the other; the bone first, then the muscle. Therefore, when the tibia and fibula (fibula) grow, the muscles forming the sural triceps (gastrocnemius and soleus) are too short and exert too much traction on the Achilles tendon, which itself pulls on the calcaneus. In a child who does not play sports, some pain may appear during short days, but in an athletic child or a child with a postural imbalance, the traction of the Achilles tendon is too great. This is why it is necessary, in this type of child, to stretch the calves regularly in order to lengthen the muscle fibers and avoid the Achilles tendon being overstretched.

• Pain located at the back of the heel or under the heel: in fact, the Achilles tendon is inserted around the heel bone including underneath. Too much traction of the tendon will have repercussions on the whole bone.
• Often the child walks on the folded edge of the shoe to shorten the Achilles tendon.
• The pain can affect both heels but often, especially at the beginning, it affects only one side.

The diagnosis is essentially based on the interrogation and the clinic

• When questioned, the patient complains of pain as soon as he is leaning on the heel which is in pain, when he jumps and when walking or running at the moment of propulsion, i.e. when the calf contracts.
• On clinical examination, pressure on the heel generated by the examiner's hand causes exquisite pain. The contraction and stretching of the sural triceps also reproduces the pain.

Imaging tests are not necessary.

• Eat a healthy and balanced diet
• Stretch regularly
• Playing sports with adapted shoes

Ice should be used to relieve pain since cold has an analgesic effect. Applying it for 10-15 minutes during pain but also after sports training can bring real relief.

As explained in the section "Causes of Sever's disease", it is important to stretch the muscle fibers upstream, i.e., in prevention, before the pathology sets in, but also when the disease is present, while respecting the rule of no pain.

To do this, simply stretch your calves, here are some examples:

In the case of Sever's disease, a podiatric assessment is necessary to eliminate any mechanical cause of poor positioning of the foot or knee that would generate an angulation of the Achilles tendon. In these cases, the podiatrist may have to make insoles to realign the tendon, as well as to "straighten" the foot. The wearing of these insoles can be transitory because during a next growth peak, guided by the insoles, the architecture of the ankle-foot complex can be improved.

Wearing a transitional heel cup has a beneficial effect because it allows the Achilles tendon to rest a little. However, it is essential that the wearing of the heel pad be short! Only to relieve the patient!

They should absolutely not be worn for a long time, because as we have seen above, it is necessary to stretch the calf muscles and therefore maintain tension on the Achilles tendon. When we put on a heel cup, we shorten it, it is then less tense and the traction on the heel is reduced, so the patient is relieved. But the muscle does not lengthen! And during the next growth peak, the bones will continue to grow and the muscle will become even shorter, so the height of the heel pad will have to be increased more and more.

The heels should be worn for a few weeks at most,
never for a long time!

Osteopathy aims to treat the patient as a whole, starting with the cause of the complaint. The osteopath will therefore investigate each joint of the body to understand where the problem comes from. Is the pain related to a reduced mobility of the ankle or a knee that is too flexed? 

The osteopath's role will be to correct the cause if he can and to treat the consequences that it may have had on the rest of the body thanks to specific, adapted and painless techniques.

During an osteopathic consultation, your osteopath will explain to you what he has found and how to manage it, as well as the advice you can apply. He will also know how to redirect you to a health professional in order to treat Sever's disease in a multidisciplinary way.

Marie Messager
Osteopath D.O. specialized in pediatrics
Versailles sites
78000 - Yvelines