Q: My 12-year-old daughter has been in pain for the past three years. It started as what the doctors called Sever’s disease, pain in the heels that became evident while playing soccer in shoes that are not made for supporting youth feet. From there the pain radiated all the way up her leg joints and muscles and into her hips. We saw an orthopedic who prescribed orthotics with no relief. Her hips hurt all the time and pop when she moves. She used crutches for a summer and could not participate in any physical activity. We were chalking it all up to growing pains since blood tests, X-rays, MRIs and bone scans did not reveal anything that would explain her pain.
There Is no rash, no fever, no bruising, no nothing. They’ve ruled out rheumatoid arthritis, fibromyalgia and everything else we thought it could be. We visited Children’s in Milwaukee and the doctor there suggested there’s some kind of pain from her past that is manifesting itself in the form of physical pain. I explained that I respectfully disagreed. We had new blood tests run recently through our pediatrician and because they cannot find a reason for the pain and since the tests were normal, he agreed with the other doctor and suggested a pain management center and antidepressants. We feed her Aleve like candy because it’s the only thing that helps and it only helps a little.
A: Sever’s disease is a painful bone disorder that begins with swelling of the growth plate in the heel. It is more common in males than in females. During growth spurts that commonly occur in girls between the ages of 10 and 12 and boys between the ages of 12 and 15, there are instances when the heel bone grows faster than the tendons and leg muscles do. The occurrence causes them to become tight and overstretched, which makes the heels less flexible and puts undue pressure on the growth plates. Your daughter likely began experiencing her problems during a growth spurt because following the age of 15 or thereabouts, the backs of the heels have completed growing. Over time with pressures such as her soccer events, the repeated force resulted in the pain of Sever’s disease. Her shoes were apparently contributory to the pain she is experiencing but hindsight, as they say, is 20/20. The condition has also been known to occur in individuals who stand still too long while wearing shoes without proper cushioning.
Signs and symptoms include pain at the top of the list in one or both heels, stiffness and discomfort (particularly on awakening in the morning), walking with a limp or on tiptoes to avoid placing pressure on the heel, and more.
Some physicians (obviously those who have not been diagnosed with Sever’s) feel the condition, while painful, is mostly temporary. It generally has a good prognosis. While some individuals may be fortunate enough to outgrow the disorder, it increases the risk of high arches, flat feet, a foot that will roll in at the ankle when walking or running, and obesity.
Treatment begins by reducing the level of pain and decreasing of inflammation present. Sadly, this always includes a discontinuation of activity that places pressure on the heel bone(s) until the symptoms disappear completely. While the individual may be told not to run barefoot on hard surfaces, such activities as swimming, biking and non-impact functions might be allowed; however, any exercise should be approved by the physician in charge who might recommend the use of a compression stocking to help with inflammation, exercises to strengthen the muscles and tendons of the leg(s), elevation of the leg(s), the application of ice following activity, and over-the-counter acetaminophen or ibuprofen. Aspirin is discouraged and should only be used with a physician’s permission because of the risk of Reye syndrome. The sooner therapy is introduced, the faster the recovery.
I am concerned that your daughter has had this condition for three years. Pain management may be indicated and close follow-up over the next year is critical because what may have begun as Sever’s may manifest into other problems. This obviously is a difficult case. Consider getting another opinion at another pediatric academic center. Good luck.
