Remember! Our guides are to be used following an assessment with a qualified medical professional. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physiotherapist.

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Sever’s Disease Physical Therapy Guide

What Is Sever’s Disease?

Sever’s disease was fist described by Dr James Sever in 1912 and is often referred to as Calcaneal Apophysitis. Sever’s disease is a very common cause of heel pain and affects millions of skeletally immature children every year. Sever’s is the result of direct inflammation of the Calcaneal apophysis (growth plate) during childhood and is common in adolescent boys and girls. Repetitive contraction of the calf muscles that come together to form the achilles tendon causes a pull on the growth plate during resisted ankle movement such as sprinting, thus creating painful inflammation. It frequently occurs before or during the peak growth spurt and often immediately after a child begins a new sport / season.

What Causes Sever’s Disease?

Sever’s is a common cause of heel pain in athletes and active adolescents aged 5-11 years, it is 75% more common in physically active boys that girls. Approximately 60% of cases are affected on both legs. The condition develops earlier in females comparted to males due to gener differences in skeletal development. Severs disease is often associated with a rapid growth spurt. As the bones grow, the muscles and tendons often cannot keep up with the bone growth, and become tighter as a result. The main contributing factor of Sever’s disease is tight calf muscles; tight calves restrict the adolescents ankle range of movement which results on more strain on the achilles tendon, and therefore increases the likelihood of developing the condition.

What Are The Symptoms Of Sever’s Disease?

The most common sign of Sever’s disease is pain at the base of the Achilles tendon, often the pain is so severe that after physical activiy the child will limp to take weight off the affected heel. Ankle dorsiflexion is also limited and painful due to the tight calf muscle which can limit the ability to perform in their chosen sport. The main symptoms include:

  • Pain, tenderness and or redness in the affected heel(s).
  • Muscular tightness in the back of the heel and lower leg.
  • Heel pain that worsens after performing sports that involve running or jumping, and feels better after rest.
  • Difficulty weight bearing pain-free, walking or running may also have a limp present.

Severs Risk Factors

  • Age: Sever’s disease is more common in boys between the ages of 10 and 15. In girls, it usually happens between 8 and 13.
  • Foot pronation: A foot that rolls in may cause tightness and twisting of the Achilles tendon, thus increasing its pull on the heel’s growth plate.
  • Collapsed Arches: Over-pronation causes the child to develop an abnormal walking pattern, to correct it is beneficial to use an arch support, our favourite can be found here!
  • Obesity: Being overweight will place an extra load through the growth plate and may predispose adolescents to develop Sever’s disease.
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Gel Heel Supports

A soft cushioning heel raise (such as a gel pad) is a vital tool to combat Sever’s disease. Wearing a heel raise will improve shock absorption through the ankle when walking/running and ensures that the growth plate is slightly protected. It will also place the foot into dorsiflexion and as a result will offload the tight calf muscle.

What Are My Treatment Options?

There are many treatment options available to adolescents who suffer with Sever’s disease!

Rest & Time

Initially, you need to stop doing the activities that caused the heel pain to develop in the first place but also prevent agitating it further. When you feel any of the symptoms listed above, you should commence the RICE protocols below:

  • Rest. Rest, relax and protect your painful ankle joint. Stop, change, or take a break from any activity that may be increasing your pain.
  • Ice. Cold packs will help reduce the pain and swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. Do no place ice directly on to skin, wrap it in a towel first to avoid ice burn! You can find our favourite ice pack here!
  • Compression. Wrapping the ankle with a compression sleeve will help decrease swelling and improve recovery time.
  • Elevation. Elevate your feet to reduce swelling and bruising in your heel.

Physical Therapy

Although resting and activity avoidance is a vital component of the recovery process, it doesn’t mean the affected heel has to be completely immobilised. Rehabilitation must take place once all symptoms have gone so as to avoid making the condition worse!

Sever’s Disease Exercises

1) Towel Stretch

Your calf muscles are located in the back of your lower leg, and are responsible for movements in which your foot points downwards (such as applying the brakes in your car). The Calf is made up of two large muscles called the Gastrocnemius and the Soleus. Having a tight calf is one of the major reasons people develop strain, so get stretching!

How to do it:

  • Sit on the floor or on your chair with a towel or a resistance loop band wrapped around your injured foot.
  • Gentle pull the band towards you forcing your ankle into dorsiflexion (toes pointing towards you)
  • Pull until your feel a comfortable stretch in your calf muscle and hold for 15 seconds.

Repeat 5 times, three times throughout the day.

2) Soleus Stretch

The Soleus stretch targets the Soleus muscle which is deeper, underneath the larger Gastrocnemius muscle. Bending the knee relaxes gastrocnemius, allowing Soleus to be stretched in isolation.

How to do it:

  • Standing with one leg in front of the other, have something in front of you to hold on to.
  • Bend both knees, focusing on the front knee.
  • Move your weight forwards onto your toes ensuring you don’t lift off your heel.
  • Hold for 15 seconds.

Repeat 5 times, three times throughout the day.

3) Stair Stretch

The stair stretch is both a stretching and strengthening exercise, and places a great amount of tensile load through the achilles tendon and belly of the calf muscle. This exercise is for people who are reaching the end of their rehab and aren’t suffering from pain whilst exercising.

How to do it:

  • Standing on a step or a block with the heels of your feet overhanging the edge.
  • Slowly allow your heels to continue going in a downwards direction until you feel a comfortable stretch in your calves.
  • Hold the stretch for 10-15 seconds, before slowly going back to neutral.

Repeat 5 times, three times throughout the day.

4) Stair Raises

Stair raises are novel yet effective exercise for Sever’s by stretching and strengthening the Tibialis Anterior muscle. As the name suggests, this exercise is also completed on a step or a curb, however facing downwards rather than upwards.

How to do it:

  • Standing on a step or a block with the heels of your feet on the stair, while the rest of your foot is hanging off (hold a rail for balance)
  • While keeping your legs straight, point your toes downward as far as you can, then lift them up as far as you can. Repeat multiple times for 30 seconds quickly with a full range of movement.
  • After 30 seconds, bend your knees to a 45-degree angle (about half way). complete another 30 seconds of flexing in that position.
  • Rest for a minute or two, then do another set—30 seconds with the legs straight, immediately followed by 30 seconds with the knees bent.

Repeat for 5 sets of 30 seconds each, twice a day.

5) Resisted ROMs

It’s a great idea to strengthen the muscles in your foot and lower leg to provide support and stability to the ankle joint, and the easiest way to do so is by using a resistance band! Your ankle moves in multiple directions but for the sake of this guide we will be completing dorsiflexion, plantar flexion, inversion and eversion (ankle up/down/side to side). Check out DoctorJo’s video for a full description here!

How to do it:

  • Sit on the floor with a block under your achilles with a theraband tied around your injured foot, holding the other end of the band in your hands.
  • Slowly push and pull your foot towards/away from you forcing your ankle into multiple different directions.
  • Slowly let your foot return to the starting position

Repeat 15 reps, three times throughout the day.

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Foam Rolling

Deep massage of the affected gastrocnemius is a painful treatment intended to speed up the recovery process of Sever’s disease, which is often used by Physical Therapists, but can be performed by the patients themselves. The purpose of deep massage is to improve the mobility of the muscular tissue and prevent adherent scars forming. The massage is deep and can be very sore for people suffering from tight calves, however the movement encourages realignment and lengthening of the muscle fibres and will improve your recovery time.

You can buy our favourite roller here!