Sever?s disease is a condition occurring in pre-adolescents that causes pain, swelling and soreness in the heel bone, also known as the calcaneus. Sever?s disease causes pain on either side of and/or on the bottom of the heel. During a period of pre-adolescent development, the growing heel bone can be overused when the child is involved in a lot of running and jumping activities. Impact on the heel bone and repeated traction on the growing bone from the Achilles tendon can lead to swelling in the area.
The condition generally occurs in active children at early adolescence during rapid growth periods as the heel bone can grow faster than the leg muscles causing them to become tight and overstretched. Sever?s disease most often caused by inadequate footwear, playing sport on hard surfaces, calf tightness and biomechanical problems.
The condition can be quite disabling and tends to affect those who are very busy with sporting activities. In the initial stages of the condition, most children displaying signs of Severs disease will tend to hobble or limp off the sports field or court and complain of sore heels near the end of activity. As the condition progresses, children may complain of pain during activity and in severe cases prior to sporting activities. Kids heel pain can be quite discouraging for active children but, early treatment can resolve this type of foot pain in children very quickly.
To diagnose the cause of the child?s heel pain and rule out other more serious conditions, the foot and ankle surgeon obtains a thorough medical history and asks questions about recent activities. The surgeon will also examine the child?s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.
Non Surgical Treatment
The immediate goal of treatment is pain relief. Because symptoms generally worsen with activity, the main treatment for Sever's disease is rest, which helps to relieve pressure on the heel bone, decreasing swelling and reducing pain. As directed by the doctor, a child should cut down on or avoid all activities that cause pain until all symptoms are gone, especially running barefoot or on hard surfaces because hard impact on the feet can worsen pain and inflammation. The child might be able to do things that do not put pressure on the heel, such as swimming and biking, but check with a doctor first.
To prevent recurrence, patients, parents, coaches, and trainers should be instructed regarding a good preexercise stretching program for the child. Early in the season, encouragement should be given for a preseason conditioning and stretching program. Coaches and trainers should be educated about recognition of the clinical symptoms so they are able to initiate early protective measures and seek medical referral when necessary.
High arch (cavus foot) is a condition in which the arch on the bottom of the foot that runs from the toes to the heel is raised more than normal. Because of this high arch, excessive weight falls on the ball and heel of the foot when walking or standing causing pain and instability. Children with neurological disorders or other conditions such as cerebral palsy, spina bifida, poliomyelitis, muscular dystrophy are more likely to develop cavus foot. It may sometimes occur as an inherited abnormality.
Flatfoot can have many different causes. It could be a weakness or a structural abnormality you?ve had since birth. It could also mean that tendonitis, damage to the connective tissues, arthritis, or nerve problems have affected the structures in your feet. Even wearing unsupportive footwear can lead to weakness and arch pain. Whatever the cause, many conservative, noninvasive treatments exist to help relieve and eliminate your discomfort.
Persistant pain and selling under the ball of the foot and extending towards the toes (most commonly the 2nd). Some swelling may be disable on the top of the foot along with redness. Often a sensation of 'walking on the bones for the foot' will be described, and there is a positive Lachman's test. Often a tear will result in the toes splaying (daylight sign) and clawing.
The doctor will examine your feet for foot flexibility and range of motion and feel for any tenderness or bony abnormalities. Depending on the results of this physical examination, foot X-rays may be recommended. X-rays are always performed in a young child with rigid flatfeet and in an adult with acquired flatfeet due to trauma.
Non Surgical Treatment
There are many treatments for fasciitis. The most common initial treatment provided by the family doctor are anti-inflammatory medications. They may take the edge off the pain, but they don't often resolve the condition fully. Steroid injections, which deliver the medication directly to the most painful area, are usually more effective. Rest, ice, weight loss, taping, strapping, immobilization, physiotherapy, massage, stretching, heel cushions, acupuncture, night splints and extra-corporeal shock wave therapy all help some patients.
Fallen arches may occur with deformities of the foot bones. Tarsal coalition is a congenital condition in which the bones of the foot do not separate from one another during development in the womb. A child with tarsal coalition exhibits a rigid flat foot, which can be painful, notes the patient information website eOrthopod. Surgery may prove necessary to separate the bones. Other foot and ankle conditions that cause fallen arches may also require surgery if noninvasive treatments fail to alleviate pain and restore normal function.
Massage therapy is a great way to loosen muscles and help improve mobility in in your feet. As many people with foot pain have discovered, tight muscles in your legs or back can lead to tense foot muscles. All those muscles are connected, so tension in your back can cause tension in your legs which can pull the tendons in your feet and cause stiffness and pain. Getting acupuncture or a professional full body massage are probably the best ways to deal with this, but there are also some simple tricks you can do at home to help keep muscles limber. These are great for loosening up and improving circulation, both before and after exercise. Place a tennis ball under the arch of your bare foot and roll it around, stretching the muscles in your foot and promoting blood flow. You can also roll the ball under your calves and upper legs to work out stiffness and knots. If you feel the tennis ball is too easy, try a lacrosse ball for deeper massaging. This is also demonstrated in the exercise video above. Use a foam roller, those big overpriced rolls of foam that are now available in every department and sporting goods store are fantastic for self-massage (why a roll of foam costs $30 is beyond us, but they do work wonders-our advice is to not waste money on the more expensive fancy grooved ones because even the simplest rollers work great). The exercises you can do with foam rollers seem to be endless, and there are literally hundreds of free videos online showing how to use them to massage every part of your body. Here's one we picked out that specifically targets foot and leg muscles related to arches and plantar fasciitis.
Posterior tibial tendon dysfunction (PTTD) is an inflammation and / or overstretching of the posterior tibial tendon in the foot. An important function of the posterior tibial tendon is to help support the arch. But in PTTD, the tendon?s ability to perform that job is impaired, often resulting in a flattening of the foot. PTTD is often called ?adult-acquired flatfoot? because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse-especially if it isn?t treated early. This differs from flexible flatfoot because flexible flatfoot typically begins in childhood or adolescence and continues into adulthood. It usually occurs in both feet and generally progresses in severity throughout the adult years. As the deformity worsens, the soft tissues (tendons and ligaments) of the arch may stretch or tear and become inflamed. The term ?flexible? means that while the foot is flat when standing (weight bearing), the arch returns when not standing. In the early stages of flexible flatfoot arthritis is not restricting motion of the arch and foot, but in the later stages arthritis may develop to such a point that the arch and foot become stiff.
There are numerous causes of acquired adult flatfoot, including fracture or dislocation, tendon laceration, tarsal coalition, arthritis, neuroarthropathy, neurologic weakness, and iatrogenic causes. The most common cause of acquired adult flatfoot is posterior tibial tendon dysfunction.
Symptoms shift around a bit, depending on what stage of PTTD you?re in. For instance, you?re likely to start off with tendonitis, or inflammation of the posterior tibial tendon. This will make the area around the inside of your ankle and possibly into your arch swollen, reddened, warm to the touch, and painful. Inflammation may actually last throughout the stages of PTTD. The ankle will also begin to roll towards the inside of the foot (pronate), your heel may tilt, and you may experience some pain in your leg (e.g. shin splints). As the condition progresses, the toes and foot begin to turn outward, so that when you look at your foot from the back (or have a friend look for you, because-hey-that can be kind of a difficult maneuver to pull off) more toes than usual will be visible on the outside (i.e. the side with the pinky toe). At this stage, the foot?s still going to be flexible, although it will likely have flattened somewhat due to the lack of support from the posterior tibial tendon. You may also find it difficult to stand on your toes. Finally, you may reach a stage in which your feet are inflexibly flat. At this point, you may experience pain below your ankle on the outside of your foot, and you might even develop arthritis in the ankle.
The adult acquired flatfoot, secondary to posterior tibial tendon dysfunction, is diagnosed in a number of ways with no single test proven to be totally reliable. The most accurate diagnosis is made by a skilled clinician utilizing observation and hands on evaluation of the foot and ankle. Observation of the foot in a walking examination is most reliable. The affected foot appears more pronated and deformed compared to the unaffected foot. Muscle testing will show a strength deficit. An easy test to perform in the office is the single foot raise. A patient is asked to step with full body weight on the symptomatic foot, keeping the unaffected foot off the ground. The patient is then instructed to "raise up on the tip toes" of the affected foot. If the posterior tibial tendon has been attenuated or ruptured, the patient will be unable to lift the heel off the floor and rise onto the toes. In less severe cases, the patient will be able to rise on the toes, but the heel will not be noted to invert as it normally does when we rise onto the toes. X-rays can be helpful but are not diagnostic of the adult acquired flatfoot. Both feet - the symptomatic and asymptomatic - will demonstrate a flatfoot deformity on x-ray. Careful observation may show a greater severity of deformity on the affected side.
Non surgical Treatment
Initial treatment for most patients consists of rest and anti-inflammatory medications. This will help reduce the swelling and pain associated with the condition. The long term treatment for the problem usually involves custom made orthotics and supportive shoe gear to prevent further breakdown of the foot. ESWT(extracorporeal shock wave therapy) is a novel treatment which uses sound wave technology to stimulate blood flow to the tendon to accelerate the healing process. This can help lead to a more rapid return to normal activities for most patients. If treatment is initiated early in the process, most patients can experience a return to normal activities without the need for surgery.
Flatfoot reconstruction (osteotomy). This is often recommended for flexible flatfoot condition. Flatfoot reconstruction involves cutting and shifting the heel bone into a more neutral position, transferring the tendon used to flex the lesser toes (all but the big toe) to strengthen the posterior tibial tendon, and lengthening the calf muscle. Fusion (also known as triple arthrodesis). Fusion involves fusing, or making stiff, three joints in the back of the foot the subtalar, talonavicular, and calcaneocuboid joints, to realign the foot and give it a more natural shape. Pins or screws hold the area in place until it heals. Fusion is often recommended for a rigid flatfoot deformity or evidence of arthritis. Both of these surgeries can provide excellent pain relief and correction.