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Another Sever's Question...Pain not really in heel!

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Gymanna

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Jun 25, 2014
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Hi,

My daughter (8 y.o. gymnast) has been diagnosed with Sever's. :-(

She is walking on her toes on that side, pain flares up after activity etc. But when I look at all the info it is heel pain which is the main symptom. My daughter's area of pain is more towards her inside ankle - behind and under her ankle joint. She has had x-rays and ultrasound to rule out anything else major and I think that the diagnosis is sever's because they have run out of other options.

I was wondering if anyone else's gymnast had experienced pain in this site for Sever's??

Thanks!!!
 

thefellowsmom

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My dds "severs" pain wanders all over the place. I highly recommend this book...

Trigger point therapy workbook - http://amzn.to/1PR0Mp7

And also this...

http://gymnastcare.com/what-you-need-to-know-about-eliminating-your-athletes-heel-pain

We use a combination of massage, stretching and the ice bucket with great results. She also wears a cheetah cup when she is flailed up.

So much of this kind of stuff is caused by tightness in the calf and lower leg.

We have been able to effectively manage her symptoms and keep her going using the methods in the above book. The book takes where the pain is and points you to the specific location of tightness that you can target with massage. It's uncanny. She will say it hurts here and I will look it up and then push where it says to and she will jump right out of her chair. We always get a good laugh from that.

We also have a great manual therapist/chiropractor that she sees regularly for her previous back issues and he consults with us on her aches and pains as they come up as well. Usually just to check it out and confirm we are on the right track, work out something minor for her or advice me on exercises or home treatment ... or that it warrants further examination.

Good luck!
 
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sce

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Sever's is an inflammation of the growth plate in the heel, between the growth plate and the bone. The classic pain spot is when squeezing the sides ( not bottom) of the heel bone. Tightness in the calf and Achilles' tendon can be related and/or contribute to to it and these areas may also hurt.
 
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GlobalNomad

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DD has had pain in this area. She wears running shoes with gel heel cups. She also has a stretching protocol recommended during physical therapy. Also, she lets her feet turn in and her arches fall, so she has a foot strengthening exercise to help with that. Her PT said that the Sever's combined with letting her ankle turn in was causing more pulling on that side. Doing all of these things, she is not having pain now.
 
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@agscc401

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I'm going off on a limb here... but could it be posterior tibial tendinitis? I had pain in that area... that was one of my diagnosis... in addition to os trigonum, but I'm pretty sure that only shows up on MRI's/CT's but I'm not sure.
 
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gasrgoose

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Try to encourage her not to walk on her toes as that will continue to let the achilles tighten which will make the problem worse. (easier said than done) Wearing a walking boot is a great solution for this because it keeps the foot in the flexed position. Finding something she can sleep in with her foot flexed was the solution that worked for my daughter. After saying that I realize that some solutions work for some that won't for others. I also massaged my daughters feet and calves which also helped though it was slightly painful. Typically I'd rubbed them aggressively to begin with and then finish with a more relaxing massage so she would remember that it felt good and let me do it the following night. I'll warn that this is a slippery slope, she hasn't had severs in a couple of years but I'm still rubbing her feet ;)
 

SurpriseGymMom

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My DDs severs hurts on the inside of the ankle, right down by where it meets the foot. Definitely towards the backside of the foot, but not right at the heel, more straight down from the "bump". ;)
 
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B.Gold

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...what thefellowsmom said, the pain wanders.
Try to encourage her not to walk on her toes as that will continue to let the achilles tighten which will make the problem worse.
An interesting side note to this, my dd's PT has pointed out to me that severs is so common in gymnasts not just because of all the pounding on their feet, but because of all the time spent with pointed toes. It's soo important to stretch that achilles!
 

gasrgoose

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...what thefellowsmom said, the pain wanders.

An interesting side note to this, my dd's PT has pointed out to me that severs is so common in gymnasts not just because of all the pounding on their feet, but because of all the time spent with pointed toes. It's soo important to stretch that achilles!
^^^^^^^Yes, yes! That is why heel cups don't seem to do much. They just provide a cushion to protect the sensitive area but they do very little to alleviate the cause of the problem. I actually think heel cups make the problem worse by elevating (it's not much but makes a difference) the heel and making the achilles tighter. My daughter would walk around on her toes also because it didn't hurt that way. I couldn't imagine the calf strength required, but it was prolonging the problem. Someway or another the achilles and calf have to be stretched so the achilles will not pull so hard against the growth plate on the heel. Also rolling a ball under the arch of the foot helps but can be painful also.
 

Gymanna

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thanks so much for all the replies and suggestions. I have read through them all and appreciate the links.

I'm going off on a limb here... but could it be posterior tibial tendinitis? I had pain in that area... that was one of my diagnosis... in addition to os trigonum, but I'm pretty sure that only shows up on MRI's/CT's but I'm not sure.
very well spotted! She actually had a U/S to rule this out as tibial tendinitis was the initial possible diagnosis. So back to the Sever's camp.....

I just can't get her to stop walking on her toe as she says it hurts too much! We are doing massage, icing and stretching. Her calves aren't tight but with her walking, no doubt her achilles is tight. Will ask the PT about a boot for a few weeks maybe if you think that it will help her to not walk on her toes and enforce some R&R. Do your gym kids still work out in the boot? or are you out of the gym completely?
 

B.Gold

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That is why heel cups don't seem to do much. They just provide a cushion to protect the sensitive area but they do very little to alleviate the cause of the problem. I actually think heel cups make the problem worse by elevating (it's not much but makes a difference) the heel and making the achilles tighter.
Wow!! You're right! We've instinctually stayed away from heel cups, but I could never put my finger on why. That explanation is spot on!

Also rolling a ball under the arch of the foot helps but can be painful also.
We also do this at the recommendation of her PT with a very hard lacrosse ball.... and I also manually message that area as well.
 

looly

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One thing that can help is to have her sleep in athletic shoes - it will keep the foot in a gently flexed position during the night, which will keep the calves and Achilles from being as tight in the morning. It won't fix the problem but it may help a little, and it's free :)
 

@agscc401

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There are devices/braces to keep the foot flexed.. but you can also sleep in athletic shoes or the boot if you get one. I would ask the PT about a boot... maybe a short one if they have it available (as opposed to tall). If she is enough pain that she can't walk normally, I think a boot would be a good move. Eliminate non-sneakers for a while.... maybe even invest in another pair of sneakers (with more support/cushion/gel... like asics?), that might relieve some pain throughout the day. If you get a boot just make sure she wears a taller shoe with it... her back/hips/knee might start bothering her from the uneven levels. She can still practice... I don't remember the level she is but depending on skills it might stay on/might come off. Because of her age I would suggest leaving it on because she is a little bit younger. Even 2 weeks would be plenty of time in a boot IMO, which is a good amount of time to work on bars, conditioning and flexibility. I haven't seen many kids stay out of the gym for severs... I would get a good PT note being specific about what she can/should do, and talk to the coaches she works with about it.
 

gasrgoose

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There are devices/braces to keep the foot flexed.. but you can also sleep in athletic shoes or the boot if you get one. I would ask the PT about a boot... maybe a short one if they have it available (as opposed to tall). If she is enough pain that she can't walk normally, I think a boot would be a good move. Eliminate non-sneakers for a while.... maybe even invest in another pair of sneakers (with more support/cushion/gel... like asics?), that might relieve some pain throughout the day. If you get a boot just make sure she wears a taller shoe with it... her back/hips/knee might start bothering her from the uneven levels. She can still practice... I don't remember the level she is but depending on skills it might stay on/might come off. Because of her age I would suggest leaving it on because she is a little bit younger. Even 2 weeks would be plenty of time in a boot IMO, which is a good amount of time to work on bars, conditioning and flexibility. I haven't seen many kids stay out of the gym for severs... I would get a good PT note being specific about what she can/should do, and talk to the coaches she works with about it.
Great advice in bold. There is nothing more frustrating than causing another problem while trying to fix one
 
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