From the SAYSO Trainer’s Notebook
Sever’s Disease and Plantar Fasciitis
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“My son plays intensely during the entire game,
but afterwards, he sometimes has excruciating pain in the heel area.” “My son cannot play more than about five minutes due to the pain.” “My daughter suffered through heel pain for about two years during the time that she was playing soccer year round. She's now almost 16, and I never hear her mention it anymore.” These symptoms may be either Sever’s (Condition) Disease or Plantar Fasciitis, with Sever’s being the more likely cause. The two different conditions exhibit similar symptoms (e.g., pain) but at different locations. An orthopedist or podiatrist is required to make a diagnosis and to prescribe treatment. |
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Sever's is an inflammation of the
calcaneal apophysis, the growth plate at the heel bone. If you reach down to
your foot, make the hand-gesture "OK" sign and encircle the back of your heel
with the index finger and thumb, that's about where the growth plate is in a
child. The pain will be at almost every spot in that ring, but nowhere else.
Sever’s occurs when the bones grow (elongate) more quickly than the tendon can
stretch, so the tendons gets really tight. The pain is caused by inflamed tissue
between the bone and the growth plate in the heel. The inflammation is caused by
the pounding the heel takes during activity. It is aggravated during physical
activities and not an uncommon result of playing youth soccer. Once the growth
plate closes (approximate age 11-13), the condition goes away. Plantar fasciitis is a problem at the back end of the arch where it meets up with the heel, just beyond the weight-bearing portion of the heel. Plantar fasciitis in young children is uncommon. The pattern of pain in plantar fasciitis is different than in Sever’s disease. It is most commonly noted as a stiffness and/or pain experienced after rest periods, such as first thing in the morning, and the pain eases up with walking and running except in the most severe cases. Plantar fasciitis rarely responds to heel cups and heel cushions. Improved arch support from changes in footwear are more effective. What to do for Sever’s First, have the pain checked out by a professional. Most of the following suggestions are based on anecdotal evidence. Sever’s is basically a "suck it up" pain tolerance issue. Like shinsplints, playing with Sever’s isn’t generally harmful. Although the only way to get relief is to temporarily stop being active, there are steps that can be done to minimize or eliminate the pain. 1. Take anti-inflammatory pain relievers before a game. 2. Apply ice to the heel area after practice and games. Rolling the foot over a frozen can of juice concentrate may also help. 3. Use heel cups inside the sock or in the shoe. A Thuli (pronounced “TOO'-lee”) pad is a heel insert that supports the heel in the shoe and provides shock absorbance. A harder heel cup, called the “M-F”, also works well. Both are available in most pharmacies and surgical supply stores. Sever's typically responds to the heel cups within a couple of weeks. 4. Wear turf shoes or other noncleated shoes. The large back studs on a normal soccer shoe transfer and concentrate the shock into the growth plate area while running. Turf shoes have multiple smaller bumps (projections, studs, etc.) that spread the force more evenly over the bottom of the foot. 5. Do heel drops. The more the tendon stretches to keep up with the bone growth, the less painful it will be. Stand on a curb or a stair and drop the heel below the toe in order to stretch out the tendons in the back of the ankle. 6. Do general leg/ankle/calf stretching. This may seem to help, although there are no specific stretches for this area of the body. 7. Wear orthotics. If your child’s feet require them, orthotics may help. 8. Rest and take time off from practices and games. If your child is having troubles just walking, then time off is indicated. At the least, limit the time that the heel is exposed to force and shock by as removing cleats and changing into flats immediately after practice and games. |