BOTC - US Lacrosse Community Forum Forums NORTHEAST LACROSSE BOTC MAIN FORUM (LI, CT, WC) Heel Pain - Calcaneal Apophysitis- Severs Disease Information

There have been quite a few kids presenting to the office this Spring with heel pain. One of the many possibilities for pain in this area of the foot can be attributed to the growth plate. I hope you find this article I wrote for Back of the Net informative and helpful.


Severs Disease could be the cause of your athletes heel pain.

Severs Disease, also known as Calcaneal Apophysitis, is a painful foot condition that usually affects active children between 8 and 15 years of age, whose heel bones are actively growing. Active children may often suffer from Severs Disease when they experience sharp, aching pain in their feet, particularly in their heels, which may cause them to change the way they walk or run. A child with a pronated foot (flat foot) or a child with increased weight will have a greater predisposition to the condition.

The main symptom associated with Severs Disease (Calcaneal Apophysitis) is localized pain in the heel of the foot (at the bottom, sides or the back of the heel) or where the achilles tendon attaches to the heel bone, or calcaneus. The condition is caused by the gastrocnemius muscle pulling on the attachment point of the Achilles tendon on the calcaneal tuberosity as well as chronic pounding to this growth plate.
This over pulling of the achilles tendon along with increased stress to the growth plate (where the heel grows from), in combination with overuse are the main culprits that triggers this condition.

The injury often is associated with running and jumping activities such as lacrosse, soccer, basketball, and track. However it can occur suddenly in children who do not participate in organized sports. This pain can be especially noticeable when a child walks or runs during any type of sporting or physical activity. Placing pressure on the area may also be extremely painful, particularly during jumping and propulsion or walking barefoot.

Initial treatment for Severs Disease should begin with limiting physical activity, as maintaining intense exercise will only cause the pain to worsen. Along with ice, elevation and physical therapy, (Rest, Ice, Compression and Elevation). If symptoms don't resolve and there are no contraindications you may add Motrin or Tylenol as needed.

Unfortunately, many times these treatments alone may prove to be inadequate. The condition, osteochondrosis at the tendon's attachment point on the Calcaneal tuberosity, may include microscopic bone chipping, inflammation and tears, and in the most extreme cases, separation of both cartilage and bone from the bone. Wearing supportive heel cups and shoes is also important in order to help keep as much stress off the heel as possible, however supportive shoes alone will not usually be effective in curing the condition.

Orthotics, custom shoe inserts, are a good way to treat the symptoms, as well as help eliminate Severs Disease completely. Orthotic devices have had great success in treating children who suffer from Severs Disease, in addition to other painful foot ailments. The orthotics will correct improper foot position while the child is weight bearing as well as provide some cushioning. If you have any further questions concerning this article feel free to contact me at the office.


Dr. Steven J. Stummer
PURESTEP PODIATRY

OFFICE LOCATIONS:

2631 Merrick Rd., Ste. 300 Bellmore, N.Y. 11710 (516) 781-9800
220 Fort Salonga Rd. (25A) Northport, N.Y. 11768 (631) 262-8505 , 0
100 Manetto Hill Road, Ste 103 Plainview, N.Y. 11803 (516) 449-1842

Melville Location 631-293-9540

My son suffers from this. Would it help him if his foot was booted for a couple of weeks?

Thank you! my daughter was complaining of heel pain of late and me being psycho dad said its all in her mind...now I feel like a heel.....

Same thing
My daughter was in boot for 3 weeks
Pain has subsided

Do cleats contribute to this? My daughter prefers sneakers over her cleats and says they are more confortable and offer better support.

My son had this issue a couple of years ago heel inserts in his cleats made a huge difference. Spend the $40.00 definitely worth it.

Pay attention to this, my son suffered for almost two years, went to Dr. and got custom inserts that made a huge difference as well as the exercises they gave and ice ice baby. there is no quick solution for this

What kind of heel inserts did you use?

My son has this same issue. We went to the doctor we have the show insets but he still has the pain. But what he did tell us is to freeze a lacrosse ball and to roll his foot on the frozen ball after working out. It seems to help him.

Both of my children dealt with this off and on for years. Ice, advil, heel cups and NO CLEATS made life bearable. They wore New Balance trail running shoes and they made all of the difference. It is very painful but it does go away. Good luck.

Tule with cross section bottoms. In for a long haul with that

Thank You BotC for this great, informative article..this is the positive that comes out of the site--refreshing!

I have known Dr Stummer for many years. He is awesome with the kids and I hope he doesn't mind but he is a very rare person.. he treats all kids the same regardless of their ability to pay!!

Very painful condition and very common. Had to just wait for my son to grow out of it. Heal inserts didn't go well into cleats.Just didn't fit well.

Hi my son same problems with heels and the Tuli's heavy duty heel cups ( under 175 lbs) just 9 dollar a pair on amazon fit well in cleat. Made a world of differnce. good luck

Thank you for the info. I think we will purchase these as a preventive measure as well.

We used this method on the way to and from practices. Roll both heels with a lacrosse ball really well. Helps a lot.

Booting is extreme initial treatment. Would try insert and orthotic therapy along with physical therapy, either in office or home, once fracture is ruled out.

Yes cleats can contribute to this especially if they are poorly padded, have worn down cleat or have cleat distribution within growth plate area.

That is correct there is no quick solution to this. The growth plate may remain open until the middle teen years so an investment in an custom orthotic with the insurance for outgrowth I have found is the best long term solution to the problem.
Limited weight bearing barefoot also is a HUGE help

You can try OTC inserts to start. If your son/daughter has a structural or muscular imbalance a custom orthotic is the way to go.

There are better treatments then using a frozen lacrosse ball unless you are stuck at a tournament and unable to get to the hotel ice machine and a CVS

Thank you for the positive feedback.
This site is very well run and the crew always do their best to get up to date organized info in a timely manner to help the kids and parents. A++

Thank you Larry. That was very nice. Hope to see you soon.

Sorry to hear that. Seems as if you had the incorrect insert.
It kills me to hear "You had to wait for your child to grow out of it" NOT TRUE. If he still has pain call me.

Glad to hear it works. It would appear your child's pain has more plantar fascia ligament involvement. Look for a proper insole with good arch support and they should have to roll out the foot. Let me know how it works out.

Just speaking the truth!! Miss you! We should have lunch one day.. Invite Larry!

Maybe Larry will join us if we can get him away from behind the back of the cage/net. Would be nice.

Saturday or Sunday, he will. I will ask him

Interesting. My 8 year-old is always begging for foot massages. I guess it's time for a doctor visit.

As a former athlete I know how important your feet is to your sport. I had issues in the past so I try to make sure my son has the proper cleats, however he's growing at an alarming rate and so is his feet. He's gone from a size 8 to 11 in less than a year. Could the lacrosse cleats with less padding and a harder bottom be an issue. I noticed the to football cleats have more give and a softer bottom with more padding.

I would love to hear your thoughts on the difference in cleats.

There are many different cleat patterns. Unfortunately many fall right under the growth plate in developing kids, causing the greatest amount of shock to be absorbed in this very fragile area.

The sole cushioning and arch support also play a very significant role in prevention of Severs. A lecture on cleats would take to long to go over in this space. You may call me or stop into the office with your child's cleats anytime.

Doctors visit if massages are to eliminate pain. If not, then its a great bonding experience and downtime to discuss life.

I have heel spur that they said the only way that I would get relief is surgery until I found these shoes. I am not kidding. Have no more problem with my spur. My wife seen what relief I was having and she got her a pair we both work on concrete for 8 hours a day. We love them. I wish you would put more styles in wide. Thank you keeps up the great work orthofeet. I have 3 pair of the men's shoes and love them.