Is Severs Disease a stress fracture?
There are numerous causes of heel pain in adults, but in children the commonest by far is a condition known as Severs disease. Since this is an injury to the growing plate at the back of the heel bone, it wouldn't happen in adults. The most common age of developing is about the early teenage years or maybe a bit before. When we are born the heel bone develops from two parts, one being the major area of the heel bone and another being the growth area at the back of the heel bone. These two zones of bone are split up by a zone of cartilage. Severs disease occurs when there is a lot of force on that area of cartilage.
The leading causes are simply excessive activity done to increasing amounts so that the bone does not get enough time to get used to the stress that are placed on it. Almost always the child is involved with a great deal of sports activity, often on hard surfaces. Limited calf muscles can also be frequently present. The primary sign is soreness around the edges of the heel bone at the back of the heel and soreness on weightbearing. Increasing the amount of sporting activity also makes it worse.
The important approach to the management is a lowering of physical activity so that load on the growing zone of bone is reduced. Commonly a soft heel raise is required to protect the area and lower the force in the Achilles tendon. Ice after physical activity to help with pain can be useful. If this isn't helping, a further decrease in the amount of weightbearing activity is needed and in the most difficult cases, a walking brace or cast is utilized to substantially reduce activity levels. If all this does not help, which it occasionally does, then it is just a matter of coping with it until the two zones of growing bone merge to form one and this will not be a problem.