A Sever’s Lesion causes heel pain to arise in younger athletes as they progress into puberty (around 10-14 year olds).
Initially thought to be an inflammatory condition, Sever’s Lesion is now thought to more likely be a non-inflammatory disorder relating to repetitive stress injury. This stress injury continues to aggravate the calcaneus bone, where the Achilles Tendon is attached. For this reason, Sever’s can be considered to be the ankle equivalent of Osgood Schlatter lesion of the knee.
Patients will often describe this injury as a recent change in load on the Achilles – which can result from of taking up a new sport with more running/jumping load or during/after a growth spurt. Other features include load related pain at the Achilles insertion/posterior heel, which is relieved by rest.
Patients with Sever’s lesion should be aware that it is a self-limiting condition. This means that this condition can/will resolve itself; however (in severe cases) symptoms can last up to 2 years.
Fortunately for those with Sever’s Lesion, continuing to be active and participating in sports is thought to have little to no effect on the duration of the condition. This means that there should be no negative impact on the condition by continuing to play sports. To reduce the impact of Sever’s lesion on sports participation, it is suggested that physiotherapy can help relieve symptoms and assist recovery back to original physical condition.
Cornerstones of management of Sever’s Lesion are similar to that of tendinopathy treatment, which involves modifying controllable risk factors;
- Load management: Short term reduction of aggravating activities – then progressive reintroduction.
- Addressing strength deficits of the kinetic chain: May include foot, calf, hamstrings and gluteal strength exercises.
- Addressing biomechanics and loading techniques to ensure efficient transfer of load
- Adjunctive soft tissue and joint manual therapy can be of value in the short term
Invasive management strategies may result in further injury; as such the above treatments are preferable before considering more drastic treatment options.
If you think you or someone you know has a Sever’s lesion, contact Capital Clinic Physiotherapy for education and a comprehensive management plan.