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Gymnastic Injuries: Managing My Daughter's Sever's Disease

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Sever's disease

Sever's disease

Sever's Disease Can Come on Fast

A few days before my daughter's third meet of the season, she began to complain of heel pain in her left foot. She'd been practicing hard, and I just chalked it up to overuse. When the heel of the left foot began to swell, I still didn't think much of it. We iced it, and she took some ibuprofen. For a few days, all seemed well, and neither of us thought anymore about the heel pain.

At the third competition of the year, my daughter was warming up her vault, and she was struggling. Sometimes, I notice when she's struggling even if others don't because I know her so well. I tried to get her attention from the stands, but she's all business at the meets.

When she went to warm up her vault, she couldn't hurdle and kept landing on the table. It was odd, and all the parents from our gym noticed right away that something wasn't right. She immediately ran to her coach, and I watched as they talked. Next thing I knew, my usually brave girl was coming towards the stands with tears in her eyes.

Sever's Disease Symptoms

For gymnasts, Sever's disease can be hard to distinguish from other pains. The most common symptoms of this condition include:

  • Pain
  • Swelling
  • Redness
  • Tenderness, especially towards the back of the heel
  • Tightness towards the back of the foot
  • Heel pain that begins after running or jumping
  • Pain that subsides with rest
  • Trouble walking, running, or jumping
  • Limping
  • Walking on toes to ease foot pain

Unbelievable Heel Pain

The vault was the first event of the day. When my daughter came limping over to me with tears in her eyes, I knew something was wrong. She asked for ibuprofen and went back to the competition floor.

Shortly after, I watched with bated breath as she completed her vaults. Instead of doing a half-on/half-off vault and a handspring vault, she opted just to do two handspring vaults. She made both of them and ended with a 9.05 score. I noticed as she walked away that she was favoring her right leg.

Later she told me the only way to reduce the pain was for her to walk on her tiptoes. At the time, I thought this was silly. But when she relayed this information to the doctor and later to the physical therapist, it proved to be a big part of diagnosing her injury.

Lots of Swelling and Pain for Days

By the time we left the meet, my daughter's foot was so swollen she couldn't wear her shoe. We iced it while we drove home, and I called the doctor as soon as possible. As soon as we walked into the orthopedist's office, they determined it was Sever's disease.

I was immediately worried because Sever's disease sounds like something awful. Yet, it isn't. In fact, it's common in young athletes, easy to manage, and usually goes away when they are done growing.

As soon as we hit the truck after the meet, my daughter removed her socks and shoes. I'm used to seeing her swollen here and there, but I knew this was a different kind of swollen. Unfortunately, it only got worse from here.

As soon as we hit the truck after the meet, my daughter removed her socks and shoes. I'm used to seeing her swollen here and there, but I knew this was a different kind of swollen. Unfortunately, it only got worse from here.

The Squeeze Test

With so much technology available in the medical field, I was surprised to see the doctor squeezing the back of my daughter's heel. When he put pressure on both sides of the heel at the same time, she jumped off the table. Not only was Sever's disease affecting her heel, but it was also putting great pressure on her Achilles tendon and her growth plate.

At 4' 9" and 90 lbs, my daughter wears a size-8 women's shoe. As a result, the boot looked enormous in comparison to her tiny body.

At 4' 9" and 90 lbs, my daughter wears a size-8 women's shoe. As a result, the boot looked enormous in comparison to her tiny body.

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PT and Immobilization

There are many ways to treat Sever's disease. The way the condition is treated depends greatly on the child, their activities, and how close they are to being fully grown. My daughter is 11 and a competitive gymnast, and about 75% of her growth has been completed.

Because keeping her off her feet wasn't a realistic option, the doctor opted to immobilize her foot with a walking cast, and he also ordered aggressive physical therapy. We discussed a traditional cast, but our doctor prefers walking casts because they prevent kids from losing all mobility in the foot. In this way, a walking cast can promote a faster recovery.

Physical Therapy to Improve Recovery Time

As soon as my daughter realized she was going to be immobilized, she was worried about competing. She's naturally competitive, and competitions are one of her favorite things on the planet. At the time of injury, she had a little over a month until the next competition. The doctor told her recovery could take anywhere from 2 weeks to two months. He further explained that the more compliant she was with PT, stretching, and wearing the boot, the faster she would heal and be able to compete again.

With that in mind, we attended our first physical therapy session. The physical therapist we chose is well known in our area, and he is also a competitive athlete. He really broke down the basics of this condition and explained just how common it is. He then advised my very muscly daughter to lay off the strength work and add some serious stretching to her regimen.

If you are familiar with gymnastics, you know there are basically two types of gymnasts: the lean gymnasts and the bulky gymnasts. My daughter belongs to the second category and works hard to build more muscles and a tighter core on a daily basis. What she forgets to do is work on her flexibility and her stretching. In fact, she'd rather do 20 pull-ups, 100 crunches, and run a few laps than sit in her splits for a minute. Unfortunately, this habit contributed greatly to her most recent predicament.

When the physical therapist evaluated my daughter, he was impressed by how muscular she was at such a young age—and he was even more amazed by how tight her hamstrings were. He explained to us that children with short or tight hamstrings are extremely prone to Sever's disease because of the connections in the body.

After three weeks of multiple sessions of PT, my daughter is boot-free, much more flexible, and ready to compete again. Through physical therapy, she learned how to stretch her hamstrings, calves, toes, and feet, and she also got some groovy preventative compression socks with sewn-in heel cups to help prevent Sever's disease from recurring.

Understanding Sever's Disease

Sever's disease occurs most often in girls ages 10–15. While it can surely affect any child, it is most common in athletes—especially gymnasts, soccer players, and basketball players.

During a rapid growth spurt, the heel bone grows extremely fast. When the heel bone grows faster than the ligaments, muscles, and tendons, it can cause problems and pain that lead to a heel injury. The best way to deal with this is to address it and not ignore it. An athlete suffering from Sever's disease needs to learn how to stretch their muscles, rest when needed, and wear specialized gear to prevent the disease from taking them out of the game.

Her Treatment Plan and Prognosis

The awesome thing (if there can be such a thing) about this diagnosis is that it isn't permanent and it's easily managed. My daughter should simply outgrow it.

In the meantime, she has some work to do. She now needs to wear the Cheetah compression socks with heel cups when she tumbles, vaults, and even on the beam. She also has to stretch carefully, paying special attention to her hamstrings, calves, ankles, and toes.

For heel pain, the doctor recommended anti-inflammatory medications and ice. However, if the pain lasts for more than a few days, we need to go back to physical therapy. But, if she follows the guidelines she's been given, she shouldn't have to sit out at gymnastics or be immobilized again.

The best part is that she will eventually grow out of this condition. Since Sever's disease is related to growth spurts, she shouldn't have any more issues with heel pain once she is done growing.

Tuli's Cheetah Heel Protectors for Sever's Disease

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2016 Tawnya

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