Sever's disease 

Sever's disease is a condition that can affect young gymnasts usually during periods of rapid growth. (Common ages are 8 to 13.)

Symptoms:

Symptoms include heel pain in one or both heels that is worsened with activity and improved with rest.

SeversCauses:

The general feeling is that it is caused by the stress placed on the calcaneal apophositis (place on the heel bone where there is a growth plate and the Achilles tendon inserts.) During periods of rapid growth when the calf muscles have stretched as far as they can during movement, they transmit force to the Achilles tendon. When the Achilles tendon has absorbed as much stess as it can, it transmits tension to the calcaneous (heel bone) at the apophysis or growth plate. When this attachment cannot absorb any more stess, microfractures develop and pain is the result.

Risk Factors:

Risk factors for its development are tight calf muscles and the inability to flex the ankle past 90 degrees before a growth spurt occurs. Increases in training intensity in tumbling activities that require foot push off and calf firing without adequate calf stretch at the end of practice are also a risk factor. Gymnasts who have to work to develop flexibility will be at greater risk than naturally flexible gymnasts.

Tips To Help Prevent this Injury:

Maintain the ability to dorsiflex the ankle to 90 degrees or greater at all times. Make sure that calf streches are done at the end of practice where significant tumbling has occurred. Massage of the calf muscles to keep muscles soft and supple and relieve pressure on the Achilles tendon during the child's period of rapid growth.

What To Do If Sever's Develops:

What Your Doctor Can Do:

Check X-rays to rule out other problems. (Often in Sever's they will be normal.) They can prescribe non-steroidal anti-inflammatory medication and a heel lift to wear in shoes during the day for pain relief. They can arrange physical therapy to utilize modalities to promote tissue healing and normalize biomechanics to prevent further injury. Depending upon the severity of symptoms, they may restrict the activities that most exacerbate it while allowing the ones that do not to minimize disruption of training schedule. Supplements can be perscribed to promote healing as well.

What You Can Do:

Keep your calf muscles soft and stretched. Utilize self massage and gentle stretches. Ice your heel (10 minutes on 10 minutes off as tolerated after practice.) Follow your doctor's orders. The GOOD NEWS is that with time and treatment, Sever's disease will usually resolve completely.
For exercises to help prevent Sever's, see the calf stretches on the exercise page.