“Oh my Gosh!!! The pain behind my heel is killing me. I can’t walk in the morning, I can’t run, play or practice. I can’t play basketball!” Parents, doctors, physical therapists and certified athletic trainers hear these words usually every season, especially during preseason. The cause of the pain usually relates to basketball players between the ages of 7 to 15 that start to exhibit symptoms of pain or tenderness in the heel (or heels), discomfort upon awaking, or when the heel is squeezed. Limping also occurs, more severe pain after walking or exercise, and increased difficulty walking, especially pain during running or playing a sport. This pain and swelling usually is diagnosed as Sever’s Disease. Sever's disease or Calcaneal Apophysitis, is the most common cause of heel pain in the growing athlete and is due to overuse and repetitive microtrauma of growth plates of the calcaneus in the heel. Many parents have heard of Osgood Schlatter’s disease, this is a similar phenomenon which takes place in the foot as opposed to the knee.
The usual cause is directly related to overuse of the bone and tendons in the heel. This can come from playing sports or anything that involves a lot of heel movement. It can be associated with starting a new sport, or the start of a new season, or too much weight bearing on the heel. Also, excessive traction could cause this, since the bones and tendons are still developing. Many children who over pronate their feet exhibit symptoms and in most patients, it usually involves both heels.
In most cases, symptoms can last for a time period of 2 to 10 weeks. It is very treatable with ice, rest and increased flexibility. Physical Therapists and Certified Athletic Trainers have been very successful in the treatment and prevention of Sever’s disease. More intense treatment would include a true stretching protocol 3 times daily of your hamstrings and calf muscles, icing 15 minutes daily 4 times a day, insertion of heel cups or orthotics may be helpful for extreme cases and rest, rest, rest. The quicker you get the irritation and swelling down the quicker you return to the court.
If you do stay on the court, it is important to prevent such overuse injuries by getting a head start on prevention methods. Physical therapists and certified athletic trainers work very hard each day to try and decrease the incidence of such overuse disorders. They will usually have basketball players wear proper fitting shoes as a proper shoe fit will decrease the incidence of Sever’s disease. Also, we will make sure that excessive running on hard surfaces is not done. As discussed, flexibility of the calf and hamstring muscles are very important. I recommend good flexibility protocols before and after training. Usually, you should warm up for about ten minutes or until you begin to break a sweat. These stretches can be done 3 times each with hold times of 15 seconds. After this you are ready to compete or practice. Stretching after practice is just as important as pre practice stretching. After practice stretching should be the same stretches as before except hold your stretches for 3 repetitions and 30 second hold times.
In closing, it is important to try to prevent Sever’s Disease so you can play all season. As soon as you start to get symptoms, follow these simple guidelines or get to your physical therapist or certified athletic trainer as soon as possible. The earlier you get treatment the quicker your return will be.