19 Mar Sever’s Disease Management and Treatment

Following on from the last blog which outlined what Sever’s disease is and the contributing factors, this week’s blog looks at common management and treatment for this often stubborn condition.

Please keep in mind this general advice and it is best to get in to see a suitably trained Podiatrist face to face to make sure the diagnosis is, first of all correct and then to receive treatment catered specifically for your child.

Treatment goals for Sever’s Disease

The first goal of treatment should be getting your child walking around with as little amount of pain and discomfort as possible.
If we cannot achieve this while they are still participating in sport then a period of active rest (explained below) may be indicated.

Even though there can be some pressures with making certain school and/or representative teams and/or competing at state, national and even international level at this age, the whole sporting picture needs to be looked at and the perspective taken that they are only children and have many years left to achieve what they are aiming for.

After looking at the whole picture and trying to identify as many of the contributing factors as possible I find deciding on initial management, whether to initiate active rest or keep the child participating in the same activity, will depend on:

1. The duration the child has been suffering from pain
2. The intensity of the pain
3. Whether it is a re-occurring presentation

This will also help determine and direct whether longer-term measures, such as trying to improve foot function with orthotic devices for long-standing and/or re-occurring presentations, will be put in place sooner than later.

Common Management and Treatment options for Sever’s Disease

A list of common management and treatment options are listed below.

• Activity management – attempting to keep the child active and moving, as long as pain levels are low, is always a goal but it may involve altering their normal weekly activity routine. This may involve resting from the less important activities/sports, from P.E., at lunchtimes and after school.  Reducing or cutting back on the number of training sessions is also sometimes a smart move.
• Ice – help manage inflammation and ease pain.
• Anti-inflammatory gel (over the counter) – as above.
• Referral for correct footwear – including school, casual and sports. Options preferably with a stiff heel counter, stiff yet cushioned sole and elevated heel to help de-load the calf and Achilles.
• Footwear management – wearing the correct joggers as often and everywhere (including around the house) – keeps the heels raised to shorten the calf and Achilles to help de-load the growth plate.
• Heel raises placed into shoes – further raises the heels to help de-load the growth plate.
• Gel heel cups – buffer the tenderness on the hard shoe heel cups and hard ground surfaces.
• Soft tissue massage – addressing potential calf tightness. Getting parents involved to aid in-between consultations can be helpful.
• Lower leg and foot strength – addressing one of the causes of tightness i.e. muscle weakness.
• Addressing core strength weakness – a weak core may contribute the calf muscles having to work harder than they should. If identified this a good referral to a Physiotherapist to further assess and give the right exercises.
• Foot function taping – to see if addressing foot function helps de-load the work the calf muscle has to do. This may all that needs to be implemented if the condition is a short term presentation.
• Active rest – if pain levels are high and we cannot reduce pain levels to a low level within an acceptable time frame then putting in place active rest is a smart option. The active part means that the child needs to stay fit and healthy by working around the condition by doing activities that don’t involve running impact on the lower legs.  This may include activities such as swimming or riding a bike and may only be for a couple of weeks or planned over a holiday period.  As I explain to the parents and child if we put this in place, as hard as it can be to have to rest it is also a good chance to work on physical weaknesses that may have been identified during your assessment e.g. calf muscle weakness, tightness and weak core strength.
• Orthotic therapy – if there is a clearly identified foot function issue, such as over-pronation, that has responded well to taping and if the child has a longer term and/or re-occurring presentation then using an orthotic device may be useful. I am careful to explain to parents this is not a “magical fix” and should only be used once other contributing factors have been identified and addressed and if the condition is either long-standing or re-occurring.

To book with Aleks for personalised advice & treatment

BILINGA (Southern Cross University Health Clinic) | Call (07) 5589 3252 |  Wednesday 8:30 am until 12 noon
BURLEIGH HEADS (Burleigh Physiotherapy) | (07) 5535 5218 |Tuesday 8 am until 2 pm; Thursday 1 pm until 6 pm;  Friday 2pm until 5pm
BROADBEACH (Raw Therapies) | (07) 5592 1341 | Tuesday 3 pm until 6:30 pm
ROBINA (Sports & Spinal) | (07) 5689 4138 | Monday 2 pm until 6 pm; Wednesday 2 pm until 6 pm

Aleks Baruksopulo is a Podiatrist on the Gold Coast with a special interest in Sports & Running injuries of the feet and lower limbs, he has over 13+ years of experience working in Physiotherapy & Sports Medicine Clinics and has performed over 22,500 patient consultations within this setting.
His business is called SportsMed Podiatry which consults out of Physiotherapy practices across the Gold Coast including at Broadbeach, Burleigh Heads, Robina and the SCU health clinic.
More information about Aleks.
Manifesto – Aleks’s Why?