Severs disease is a common problem of the heel in children. There is certainly debate if it should be called Severs Disease or calcaneal apophysitis, but we will use Severs here as it is the most commonly used term. It occurs when there is too much load on the cartilage growing area at the back of the heel bone leading to a condition that is possibly similar to a stress fracture. The classic symptoms are pain at the back the child’s heel, that is also painful to lateral squeezing at the back of the heel. The condition is self limiting as the growing area joins to the rest of the heel bone by the mid-teenage years. However, that is no reason to not treat it as its is painful and does affect quality of life.
The approach to it management to to treat the symptoms with some pain relief (ice, Oscon, anti-inflammatory drugs) and load management. Load management is related to things like heel pads to protect the painful area and a reduction of activity levels. In the child, managing this can be difficult as they like to run around and play, so some negotiation to achieve that is probably going to be needed.
As the condition is self-limited, these control of pain and load management strategies as well as managing expectations may be all that can be done over the long term until the natural history of the growth area is to merge with the rest of the heel bone. Education is the key.
PodChatLive did a real deep dive into Severs disease, interviewing an expert:
The windlass mechanism is an extremely important function in the foot. It is the foot’s own natural arch supporting mechanism, so any inhibition of this mechanism is going to affect the integrity of the foot and it biomechanics. The plantar fascia or plantar aponeurosis attaches to the bottom of the heel and the base of the toes, so spans the arch of the foot to support it. When the heel lifts off the ground the toes bend relative to the metatarsals, so they tighten this plantar fascia, giving stability to the arch and foot during the propulsive phase of gait.
If there is any issues that affect the integrity of the windlass, then there are often consequences. The arch of the foot will not be able to resist the forces that are applied to it during propulsion and will collapse. This can result in a range of different pathologies such as plantar fasciitis. Also while not being able to support the arch will also contribute to any overpronation and the consequences of that.
If there is any sort of dysfunction of the windlass there are a number of different types of interventions that can be used such as lowering the force to get it established or to get the windlass to initiate or start working earlier.
Plantar fasciitis is common and like any other problem that is common there is so much snake oil that gets marketed for it and bad advice that gets given for it. Because of this, so many cases get mismanaged and what should be an easily managed condition become a chronic difficult to manage problem.
The classic symptoms of plantar fasciitis is pain under the heal that is generally worse when getting up from rest. If you have those symptoms, then there is a pretty good chance that this is what it is. However, there are a few uncommon problems that can produce the same symptoms, hence the need to getting the diagnosis right. There is nothing wrong with self-diagnosis or self management as the simple cases are easy to treat. However, you do need to be aware that not getting one of the more uncommon conditions diagnosed and treated early can lead to a lot of unnecessary pain and discomfort.
Plantar fasciitis is due to too much cumulative load in the plantar fascia beyond what the tissue can take. This means that the basic treatment has to be directed at reducing the load and increasing the ability of the tissue to take the load. Any other treatments are just directed at the symptoms and not at these basics make a lower probability of success over the long term. There is so much differing advice been given of differing quality that may or may not be based on the most recent available evidence.
Whatever is going on with your plantar fasciitis, get the right diagnosis first and get the treatment that the scientific evidence has been shown to work better than a placebo, rather than rely on anecdotes and poor quality non-evidence based interventions.
Overpronation is a term that is widely misused and abused outside the podiatry profession. This is especially true in running communities where is is often the basis that underpins the manufacture and use of running shoes. Running shoes are typically designed or mild moderate or severe pronators. The evidence that supports this concept is either very weak or nonexistent. The evidence that shows overpronation is a risk factor for injury in runners is that it is only a very small risk factor. The evidence that running shoes should be prescribed based on the amount of pronation, is that this is not supported.
Pronation is a normal health motion in which the ankle rolls inwards and the arch collapses. Overpronaton is obviously when there is too much of this. No one really knows how much is too much and there are plenty of people who have a lot and have no problems.
A lot has been written on the nonsense and myths. At the same time, there are many people pretending to be gurus on this topic when they clearly do not understand it.
Pursing information on ‘overpronation’ on the web means using your critical thinking skills. Check the source. Check the credibility of who is posting the information. Don’t just believe something because it supports your preconceived biases.