There may be a bit of literal truth when you say your kids are growing up too fast. Sever's syndrome (SS) is a condition where the bones of the lower leg and foot grow at a rate that is faster than the surrounding ligaments and tendons. This results in shortened, tight tendons that become inflamed and irritated with normal everyday activity.
The onset of Sever's syndrome is insidious. It is slow and progressive and almost always goes unnoticed until your child discovers he or she is unable to walk without a painful limp. It usually appears between the ages of 5 and 13, when children's growth spurts are more dramatic. Classically, Sever's syndrome affects only one side of the body. Although rare, it is possible to have bilateral symptoms, so children presenting with pain on one side must have their other foot inspected thoroughly to rule out the potential for acquiring it.
The Achilles tendon is the primary structure involved with SS. It is the thickest tendon in the body. It begins at the base of the lower leg and bridges the calf and heel. When the bones attaching on either side of the Achilles tendon grow too quickly, the endpoint of either side of the tendon will become inflamed. This irritation will cause pain, especially with movement. Subsequently, we see a decline in children's ability to function when exercising, and in severe cases their ability to walk.
Usually, about six months will pass between the child's first subjective of complaint of pain and when they reach me in the clinic. Because so many children complain of minor aches and pains that alleviate within a day or so, it is difficult to evaluate a problem as serious and draw a firm conclusion that it needs intervention. Therefore I understand why so much time passes before help is sought.
A helpful tip for parents is to try and identify any trends in their child's subjective complaints or in their function. Furthermore, establishing that your child is in an active growth spurt helps to definitively rule in Sever's syndrome as a likely cause of their pain.
It is hard to estimate the lifespan of the disorder because SS is strongly dependent on the length of a growth spurt. Average cases left untreated may last anywhere from six to nine months, and up to two years in severe cases. I would caution against letting Sever's syndrome go untreated for too long as it can have a large, negative impact on a child's quality of life.
Although debilitating and sometimes chronic, Sever's syndrome responds well to physical therapy. The primary dysfunction of stiffness and tightness of the Achilles tendon and ankle joint can be alleviated with a complex series of skilled mobilizations and manipulations of the foot and ankle. These mobilizations can be taught to parents and continued via a home exercise program outside the clinic.
The exercises are so potent that relief should be immediate, and we frequently find complete abolishment of a limp within just one visit. From here, a home exercise program is designed to specifically target the most involved areas of the Achilles tendon. SS responds better to frequency rather than intensity, so it would not be uncommon for your child to have to stretch four-to-six times per day.
Cases that have progressed for a long time without treatment may take longer to resolve. In addition to mobilization, anti-inflammatory medication treatments may be indicated to assist in controlling inflammation.
Physical therapy is a quick and effective solution to combat Sever's syndrome. Nearly all cases are resolved within two weeks and severe cases generally inside of a month. Maintaining a stretching program even after the pain has gone away limits the chance of recurrence. If it does reappear, you should know that physical therapy will likely provide the same fast resolution it did in previous bouts. If you suspect that your child has Sever's syndrome, bring them in for an evaluation — we'll help you get them back on their feet.
Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He works in the outpatient division of Beverly Hospital and writes "On the Mend" weekly..Questions may be submitted to On the Mend, c/o Salem News, 32 Dunham Road, Beverly, MA 01915 or e-mail email@example.com.