This topic–Sever’s disease–was suggested by a reader on Facebook. “Like” me on Facebook here.
To be perfectly blunt, Sever’s disease is basically the pediatric form of plantar fasciitis. Both are caused by calves that are too tight, and usually the calf contracture is silent so the person is unaware that it is present. However, the two calf contractures develop differently.
(BTW, I really don’t like Sever’s being called a disease, it just sounds so bad… We also call it Sever’s apophysitis, so that might explain why disease sticks!)
In a child, usually boys around 12-13, the calf growth does not keep pace with skeletal growth, so the calf becomes “relatively too tight.” This is why these occur just after the growth spurt. This growth differential, coupled with the “straw that breaks the camel’s back” such as recent conditioning, is what gets these started. What keeps them going is a failure to address the underlying problem—you guessed it—the relative shortened calf.
The usual treatment is rest, ice, NSAID’s, immobilization, and maybe some minor efforts at stretching. If you carefully look at the list, only one of these treatments addresses the problem.
Here is one thing I do not do. I do not shut these kids down with rest and avoid all pain mentality. This is usually a nuisance and there is no “damage” going on, so I let them participate to tolerance. Read just about any website on Sever’s and you see the alarmist mentality in action.
In the adult, plantar fasciitis is also due to calves that are too tight. However, their calf tightness is due to time and inevitable contractures that come about as we age.
In both cases, there is too much strain placed through the heel due to the calf contracture. Here is what is totally cool: both these contractures can be treated, or better yet prevented, by just stretching you calves every day…
Finally, why do my well-intentioned and learned colleagues continue to treat these things with the usual dog and pony show and ignore the calf? The problem is that they can’t wrap their head around the concept that such things as Sever’s and PF can caused by such a simple problem like calves that are too tight! I for one quit drinking that kool-aid many years ago…
My wife had the surgury and it was unsuccessful. Your comments make sense to me because she does have aches and pains in her calfs and knees as well. It would be helpful to know what the calf exercises are.
Stretch everyday and use the protocol at onestretch.com
As you can see elsewhere, I like your posts very much, but I don’t like the ‘look’ of them. The font is too light and small (and not enlarge-able) for those of us with old eyes, which is probably much of your readership. It makes me slightly irritated.
Sorry to be picky. Of course I’d still rather you kept posting than be put off by the hassle of changing the platform.
I hear you and it warms my heart you got irritated. Actually changing the look is not so hard and I will give it consideration. The real problem is the font Helvetica Neuve, which I dearly love, but as you say it can be a tough read. In the meantime, there is a way to enlarge any website images and font. In mac do Command and “+” until the magnification is what you want. Command and “-” to reduce. I think Control and “=” or “-” for PC.
Stay healthy my friends,
You are a poster child for the plantar fasciitis herd mentality. If you have not read on my site at all, please do. The total message is the problem is that it is not your foot, it is your calf. The reason you have had plantar fasciitis for 6 years is that you have never treated it. Really! You are confused because of the strong message all these completely clueless medicals and non-medicals are feeding us. Just think for a second about cause and effect. The cause is often not obvious or what you think. In your case, as in the great majority of those out there suffering, looking past the obvious heel pain location is impossible. Just look at the star Mets outfielder Yoenis Cespedes. Even the pros have it wrong. This guy has been plagued with foot issues for a long time, and I can guarantee you they are related to one thing: equinus or calves too tight. And they have not focused on addressing the calf one bit. Now they are talking about a very unnecessary potential surgery.
It is getting harder for me to understand how so many can be so vehemently far off track. The evidence is there for all to see. Here is my suggestion. Do something different, something that seems so counter-intuitive and stretch your calves. Look away from the obvious, your heel, and treat the problem, your calf. There is a 95% chance you will be done, but be patient. Undoing tight calves will take time because they took years to get that way.
Break from the herd Wanda!
Stay healthy my friends,
Hi I need help making sure I am stretching right. My tennis shoes Vionic have inserts, is it ok to have them in while doing the stretches? I have only been stretching for a few weeks, i have had heal pain about a year now, will not go back to Dr. I appreciate your time and response
This one is simple which kind of makes me angry to tell you the truth. While I have my blog on my stretching method, I don’t care how or on what you stretch on as long as you fulfill four requirements: (1) you feel it in your calf, preferably the gastrocnemius or upper calf, (2) you have your knees straight, and (3) you do it for a prolonged session, not the standard 20-30 seconds. And (4) stick with it for months if needed, don’t give up when your issue is not resolved in a week or two.
Now to your shoes. That is a matter of personal preference. What you are wearing is just fine. I have some who prefer barefoot, but only a few. I hope that helps.
Of note, I noticed your comment/question is on the Sever’s disease blog. Unless you are 13 years old or less you likely do not have Sever’s, but it does not matter because stretching is still almost certain to be your answer. It is crazy good stuff.
Stay healthy my friends,
Since the dawn of the pandemic I have been suffering from plantar fasciitis in both feet with the right being the worst. I will not bore you with the details of everything I have tried as I see them in everyone’s comments! The DMP wanted to inject cortisone which I refused and was more interested in the $400 orthotics that my insurance would cover in full which I also turned down. Full disclosure – I bring a lot to the party – I had a total knee replacement (right) in 2012 and will need to do the left soon. The right heel feels like a huge nail is in it and that heel is the only place I have psoriasis and it sits right on the painful part of my heel. By some stroke of luck I found your blog today and have begun the calf stretches you detailed. THANK YOU is what I really want to say as this is the first time I feel this condition is being addressed honestly. Should I be doing just these stretches for the present time?
I am glad you found the site also. The only association with your knee issues is that they would promote equinus. Definitely do the calf stretches now and forever especially with those knees. The psoriasis is likely not part of this, but it could be and thus the stretching may take a bit longer. So, hang in there because help him on the way. In the meantime do any number of things to make things feel better (but won’t fix) and keep it cheap: higher heels, 1-2 inch and experiment, varied NSAIDs, etc. Finally, feel free to make it hurt within reason in order to be more active. The only thing to watch for is a trend of getting worse over time. For instance, you decide to get out and walk and a week later your pain is getting worse, then cut back. But if you walk and there is increased pain just after walking or out of bed the next morning, but the trend over time is not changing, then keep it up.
I am a bit disappointed because the thank you in caps made me smile and I could not get angry.
Stay healthy my friends,