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Severs Disease Treatment from the Parents Perspective

What I learnt about Severs disease as a parent

I have treated a lot of Sever's Disease cases over the years. I taught students at LaTrobe University about it for years. I have followed all the research on it and all the threads on it here at Podiatry Arena. I talked to and asked questions of those who have done their PhD's on Sever's disease. I used to believe that I knew a lot about it.... that was until I was the parent of a child who developed it!

Reflecting on some of the threads we have had on this here, there has been plenty come up over the years. The very first thread back in 2004 on Severs Disease was this one: Is Severs Disease a stress fracture? I don't think we still know if it is or is not. It could well be like a "stress fracture" of the metaphysis; but even if its not, I still find it a helpful concept to consider that it may be like a stress fracture and that can be reflected in the approach to its management.

Two threads have looked at the impact of Severs Disease on quality of life: Sever’s disease—Does it effect quality of life? and Severs disease and quality of life .. and yes it does affect the child's quality of life. So even though the condition is self-limiting, due to this impact on quality of life, it still should be treated.

One of the dilemmas I have often thought about when it comes to Sever's Disease is that, is it due to the excessive pull from the Achilles tendon on the growth plate or is it due to higher impact forces on the growth plate from the ground. Both have the potential to overload the growth plate. I still do not think we have an answer on that one. I keep considering this as you sometimes see in social media advice being asked for Sever's disease from runners about their own kids; and sometimes that advice is to start forefoot striking when they run as heel striking is the root of all evil. That is really good advice if it is due to the impact on the growth plate from heel striking, but it is atrocious and appalling advice if it is due to the pull from the Achilles tendon! Somehow the fan boys think they know more about this that those who treat a lot of it clinically.

There have been plenty of threads on the treatment of Sever's: Footwear and foot orthoses for calcaneal; Interventions for Severs Disease; Insoles effective for Severs Disease; Severs disease: orthotics vs physical therapy vs 'wait and see'; Efficacy of Using Foot Orthoses in Severs Disease; and Severs disease treatment.

However, a lot of that counted for naught when my own 9-year-old daughter got it. I did everything I had always done clinically and everything that I taught the students to do. I knew what the evidence and textbooks were saying. As far as I was concerned, I was doing everything right. But, it was not working too well; it was still hurting a lot; she sometimes cried over it. The problem was that no matter what I told her to do, she would not cut down on her activity levels. She would still run around with her friends at lunchtime at school, despite my pleading with her not to.

That is when it occurred to me that key to the management of Sever's disease is all about load management and we have very little control over that when they are at school and want to do what they want to do. Strapping, heel raises or foot orthotics can only do so much. I always knew activity levels had a lot to do with the loads, but did not appreciate until now just how important that the concept load management is. This also occurred at the time when there as a lot of shift in the understanding of load management in managing tendinopathy, so it was timely.

This is what I learnt as the parent of a child with Sever's disease. Good luck doing that when your own child does not listen to you.

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    1. Bug Jan 2, 2017
      Nice work Craig and here is the crux of it all - good luck doing that when your child doesn't listen. I wholeheartedly agree.

      I think that sums up working with kids. As the mother of two who have had Calcaneal apophysitis, one who is also an idiopathic toe walker, it has taught me so much about sometimes just rolling with it.

      You just present to parents the evidence and give the kids the knowledge on what to do if things hurt. I think we need to put it a lot into perspective and look at the long term. There is no evidence that supports it being harmful in the long term. Give the kids the power to ice and heel lifts etc when sore and let them moderate it. I'm all about tough love as a mum and sometimes let that flow into the clinic and remind the kids there is no complaining that things hurt unless they have iced and have been wearing shoes with some form of cushioning and a heel lift or their pre-fab orthotic.

      Kids will be kids and they are pretty good at self regulating. I think they when they are in less pain, they ramp up the activity and back off when they need to. We need to give them a lot more power with this and ensure that parents are on the same page. Don't forget, if it compression though - are they bigger/heavier etc. When do we approach the tricky topic of weight control.....that's another can of worms.