Introduction
Sever’s disease is a common condition that affects young football players. It is characterised by pain and inflammation in the growth plate of the heel bone. In this blog, we will explore the management of Sever’s disease in football players. We will cover what Sever’s disease is, available treatment options, rehabilitation techniques, and the importance of a comprehensive approach in effectively managing the condition.
Understanding Sever’s Disease
Sever’s disease, also known as calcaneal apophysitis, is a condition that affects the growth plate in the heel bone (calcaneus). It primarily occurs in children and adolescents during periods of rapid growth. The repetitive stress placed on the heel bone during activities like running and jumping can cause inflammation and pain in the growth plate.
Symptoms of Sever’s Disease
Sever’s disease, also known as calcaneal apophysitis, is a condition that affects the growth plate in the heel bone (calcaneus). It primarily occurs in children and adolescents during periods of rapid growth. The repetitive stress placed on the heel bone during activities like running and jumping can cause inflammation and pain in the growth plate.
Here are some common symptoms associated with Sever’s disease:
- Heel pain: Footballers with Sever’s disease typically experience pain in the back or bottom of the heel. The pain may be described as aching or throbbing and is often worse during or after physical activity, especially running or jumping.
- Tenderness and swelling: The affected area may be tender to touch, and there may be localised swelling around the back of the heel. Swelling can vary in severity and may worsen with increased activity.
- Limping or altered gait: Footballers may exhibit a limp or an altered walking pattern to avoid putting excessive pressure on the affected heel. This compensation may be more noticeable after periods of rest or upon resuming physical activity.
- Discomfort with pressure: Applying pressure to the heel, such as when wearing tight-fitting shoes or during activities that involve running or jumping, can exacerbate the pain. Footballers may find it uncomfortable to participate fully in training or competitive matches.
- Stiffness and reduced range of motion: The heel may feel stiff, and footballers may experience a limited range of motion in the ankle joint. This can affect their ability to perform certain movements, such as dorsiflexion (bringing the foot upward).
- Increased symptoms during growth spurts: Sever’s disease commonly occurs during growth spurts when the bones are rapidly growing. Footballers may notice an increase in symptoms during these periods and may have more difficulty participating in football activities.
Causes of Sever’s Disease
The exact cause of Sever’s disease is not fully understood, but several factors contribute to its development:
- Rapid growth: During growth spurts, bones and soft tissues may grow at different rates, leading to tension and stress at the growth plate.
- Overuse and repetitive activity: Football players engaging in high-impact activities, such as running and jumping, place increased stress on the heel bone and the attached Achilles tendon.
- Muscle imbalances: Weakness or tightness in the calf muscles can contribute to increased stress on the growth plate.
Assessment of Sever’s Disease
Accurate assessment of Sever’s disease is essential for diagnosis and appropriate management. The assessment process may involve the following:
- Medical history: Gathering information about the player’s symptoms, duration, and any previous injuries or activities that exacerbate the pain.
- Physical examination: The football physiotherapist will assess the foot and ankle, looking for tenderness, swelling, and any changes in foot posture. Range of motion, muscle strength, and flexibility will also be evaluated.
- Diagnostic imaging: In some cases, X-rays or MRI scans may be required to rule out other potential causes of heel pain and to assess the growth plate.
Treatment Options for Sever’s Disease
Effective management of Sever’s disease involves a combination of approaches to alleviate pain, promote healing, and address contributing factors. Treatment options may include:
- Activity modification: Reducing or modifying activities that aggravate symptoms is crucial to allow the body to heal and recover. Temporary rest from football-related activities may be necessary.
- Pain management: Non-steroidal anti-inflammatory drugs (NSAIDs) and ice therapy can help manage pain and reduce inflammation around the affected area.
- Stretching exercises: Specific stretches for the calf muscles can help improve flexibility and reduce tension on the growth plate.
- Footwear modification: Wearing supportive and cushioned shoes with proper arch support can help alleviate symptoms and reduce stress on the heel bone.
- Orthotic devices: In some cases, custom-made orthotic inserts or heel cups may be recommended to provide additional support and cushioning.
Products that may help
Voltarol Gel – Available here
This can be applied to areas of soreness to help reduce pain and inflammation.
Childrens Insole – Available here
A custom made children’s insole that provides extra cushioning and support which can help to relieve some of the symptoms associated with Sever’s disease.
Foam roller with mini bands – Available here
The foam roller can be used for self massage on the calf when the injury has settled . The mini bands are useful for strengthening or muscle activation work.
Ankle Cool Sleeve Ice Pack – Available here
This ankle ice pack provides cold therapy and compression for the entire ankle area, providing pain relief and helping to reduce swelling. The ice pack contains gel to ensure longer lasting cold therapy and the ankle specific design also provides compression to the injured area.
Rehabilitation Techniques
Rehabilitation plays a crucial role in managing Sever’s disease and preventing its recurrence. Rehabilitation techniques may include:
- Calf muscle strengthening: A tailored exercise program will focus on strengthening the calf muscles, helping to improve overall foot and ankle stability and reduce strain on the growth plate.
- Stretching exercises: Specific stretches for the calf muscles will help maintain or improve flexibility, reducing tension on the growth plate.
- Proprioceptive training: Balance and coordination exercises can enhance stability and reduce the risk of injury during football activities.
- Gradual return to football activities: Working closely with a football physiotherapist, players will follow a structured and progressive plan to reintroduce football-related movements, ensuring proper technique and monitoring for any signs of discomfort or recurrence.
Conclusion
Sever’s disease can be a challenging condition for young football players, but with the right management approach, players can overcome symptoms and safely return to the game. Understanding the nature of the condition, identifying contributing factors, and accurately assessing the player’s condition are crucial.
Treatment options focus on pain management, activity modification, and rehabilitation techniques to address muscle imbalances and improve foot and ankle stability. Rehabilitation plays a vital role in restoring function and gradually reintroducing football-related activities. By following a comprehensive approach to managing Sever’s disease, football players can overcome symptoms, minimise the risk of recurrence, and continue to enjoy their sport.
Further Reading
Martinelli et al, (2019) – Prevalence and associated factors of sever’s disease in an athletic population
Nieto-Gil et al, (2023) – Risk factors and associated factors for calcaneal apophysitis (Sever’s disease): a systematic review
Belikan et al, (2022) – Incidence of calcaneal apophysitis (Sever’s disease) and return-to-play in adolescent athletes of a German youth soccer academy
Disclaimer
The information provided in this article is for educational purposes only and should not substitute professional medical advice. Always consult with a qualified healthcare professional for diagnosis, treatment, and personalised recommendations based on your specific condition. Some affiliate links may also be used in this article, these are from products we have specifically selected to display based on our own experience.
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