Parents Yet another sever's question

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kaloss

Proud Parent
I've put a call into dd's sports med dr but no call back...and I'm concerned.

Back story, dd has complained of right heel pain off and on over the summer, finally pretty consistently for 2-3 weeks. We tried resting it, she has fabulous coaches that are very knowledgeable. She was doing constant "toe walking" on the hurt foot so we headed to the dr (pediatric sports medicine). He did X-rays, and decided she should be a in a boot for 3-4 weeks to completely immobilize her foot and give time for everything to calm down.
At her 3 week checkup, still in pain, still toe walking (she takes the boot off for showers/bed). Now her leg has woken her up 3-4 times per night with pain up to just above her knee.
Has anyone had experience with anything like this? She is now toe walking in the boot and keeps wincing out of nowhere...even when she is just sitting.
She has been in the gym on a strict conditioning only regimen since two weeks before the boot (going on 5 weeks). Strap bar, and core/arm strength only.
I'm calling the dr again Monday morning, just looking for any insight I can get before then.
Thanks!!
 
It may not be Sever's. There can be issues with the Achilles' tendon where it attaches to the back of the heel. My DD thought she had a flare up of Sever's but when I took her in was told that it wasn't. So its probably a good thing to get it checked out. FYI she was told to rest it so there wasn't a big difference in treatment.
 
I've put a call into dd's sports med dr but no call back...and I'm concerned.

Back story, dd has complained of right heel pain off and on over the summer, finally pretty consistently for 2-3 weeks. We tried resting it, she has fabulous coaches that are very knowledgeable. She was doing constant "toe walking" on the hurt foot so we headed to the dr (pediatric sports medicine). He did X-rays, and decided she should be a in a boot for 3-4 weeks to completely immobilize her foot and give time for everything to calm down.
At her 3 week checkup, still in pain, still toe walking (she takes the boot off for showers/bed). Now her leg has woken her up 3-4 times per night with pain up to just above her knee.
Has anyone had experience with anything like this? She is now toe walking in the boot and keeps wincing out of nowhere...even when she is just sitting.
She has been in the gym on a strict conditioning only regimen since two weeks before the boot (going on 5 weeks). Strap bar, and core/arm strength only.
I'm calling the dr again Monday morning, just looking for any insight I can get before then.
Thanks!!

DISCLAIMER: THERE IS ADVICE IN THIS POST THAT COMES FROM AN 11 YEAR OLD SO TAKE IT AS YOU WILL, AND MY MAIN RECOMMENDATION IS TO VISIT A PHYSIOTHERAPIST WHO SPECIALIZES IN SPORTS BUT BETTER YET GYMNASTS!

So i was about to say that this did not sound as bad as my dd with her severs, when i decided to read it to her (shes 11, dealing with severs in management phase i guess).

Her words are that your dd is probably super tight in all her leg muscles, and my dd main thing is the constant stretching and rolling of her muscles. She is also doing specific physio for her severs now.

Starting from stretching of the quads, then doing major calf and Achilles stretches, and rolling out the hamstrings and quads. If you want i can share the stretches she just explained to me but i am sure you can find that info.

But she had Sinding Larssen Johanssen which is is similar to Osgood Schlatter's which causes the pain around the knee. So she actually might be dealing with both at he same time. And get her off her toes with those stretches.
 
My daughter's Sever's first presented at about 8. She was never booted but we did go to PT for about 6 weeks to help. She took a supplement Oscon that was supposed to help with healing. It seemed to help perhaps just mentallyNow when she has flare ups we ice 3 or 4 times a day. Seems to flare up when she grows but never as bad as first time.
 
I feel bad for the amount of pain she is in...and she is so bored in the gym. She says that it hurts to do splits anymore, which makes sense that her leg muscles probably are very tight. She is tiny, and turned 8 2 months ago. Maybe she is going to finally catch up with her counterparts :)
 
We've found heat to be more effective than ice for this particular issue. Sometimes we interchange heat and ice. But we've found that because dd has very tight calves, it's a constant battle to keep her achilles flexible enough to avoid pain. We have to be regimented about stretching her calves. We also roll her legs from foot to butt since since ligaments and tendons are connected all the way up, and all of dd's are so naturally tight. All the pounding only make is worse.
We have a friend who finds that sleeping in a plantar fasciitis boot helps her a lot. It keeps her foot flexed while she sleeps which keeps her calf from fighting up.
Walking on toes and pointing toes both cause tightening of calf/achilles which aggravates sever's related pain.
I would recommend a sports PT who can show you stretches that might help her heel and her knee.
We've done PT, Theralase therapy, and stem. All of them have been helpful.
 
Sorry. Just reread above post, and it won't let me edit.
What I was trying to say about the plantar fasciitis boot is that it keeps the calf/achilles from tightening up during the night.
 
My DD also had pain at her achilles insertion, which is basically in the heel, when she had achilles tendinitis. It was the last thing to 'get better'. Now, I'm going off my memory from A&P, but I'm pretty sure that a total of three muscles actually attach to the achilles at mid-calf.

It's possible that your DDs' walking being "off" (toe walking, etc) could be stressing her muscles, tendons, etc.

What I learned during DD's P/T was that issues with hips trickle down. If your hips aren't properly conditioned, it can cause loads of issues in your lower extremities, and with her P/T came quite a bit of hip conditioning. Also, she worked P/T equally on BOTH sides of her body. Still does today - if she starts to feel like her achilles is getting a bit tight on one side, she immediately starts stretching both. Perhaps if she had been/is doing a ton of toe walking/regular walking or trying to be active with one boot on that it's causing some hip trouble which is tricking down.

These are all just vague ideas off the top of my head.

I'd definitely consult with a doc... I know you're waiting on a return call. But there are tons of fluke-y things that could be causing the pain and it's impossible to tell without an exam and maybe imaging. Please keep us updated!
 
I never post, but this an issue that we dealt with most of last year as well. After seeing 3 different orthopedists, the 3rd time was definitely the charm.
She recommended PT and that was what finally helped my DD. She leads left and had all her issues with her right heel/ankle. PT determined that right was her weaker side, so she did 12 weeks of PT working on strengthening her ankle. It was seriously like a miracle! After a year of off and on pain, she has been consistently practicing since completing PT, now she uses the techniques that she learned to help work through any pains that come up. I don't think she will ever be completely pain free in this sport but this is the best result that we could hope for. Good luck to you and your DD! PM me if you want to discuss further
 
We are in the middle of this. My daughter was diagnosed with Sever's last spring, and rested, stretched, and now wears gel cups in her tennis shoes, as well as cheetah cups for floor/vault. This year, she has added SLJ to the mix. She had some stiffness in her back (L3/L4 a bit jammed up). She was compensating for the lack of rotation in her hips, and stressed out her right calf (it was visibly bigger - and we caught this pretty quickly), and now her left knee with the SLJ.

What seems to be helping the most is consistent PT. He manually manipulates her back to ensure the vertebrae aren't jammed up, gives her tons of stretches for calf, as well as strengthening for hip adductors and core. Some laser therapy on the knee, and he heats the calf muscles, and ices the inflammed tendon areas.

It seems to be helping, but is not over yet. :-( And of course she is resistant to full on rest as we are a couple of weeks away from the state meet. At this point, we are doing PT as often as we can, and trying to go easy on practice, and just get her through the end of season. Then I'm hoping to get it cleared up completely. Now, it comes and goes...
 
I'm sorry I have nothing to add. My dd had Osgoode last year. And that was painful.
This sounds so painful for her and I wish her quick and speedy heeling.
If gymnastics wasn't hard enough they have to go through so much more - injuries, Physio, acupuncture, etc
Best wishes


I've put a call into dd's sports med dr but no call back...and I'm concerned.

Back story, dd has complained of right heel pain off and on over the summer, finally pretty consistently for 2-3 weeks. We tried resting it, she has fabulous coaches that are very knowledgeable. She was doing constant "toe walking" on the hurt foot so we headed to the dr (pediatric sports medicine). He did X-rays, and decided she should be a in a boot for 3-4 weeks to completely immobilize her foot and give time for everything to calm down.
At her 3 week checkup, still in pain, still toe walking (she takes the boot off for showers/bed). Now her leg has woken her up 3-4 times per night with pain up to just above her knee.
Has anyone had experience with anything like this? She is now toe walking in the boot and keeps wincing out of nowhere...even when she is just sitting.
She has been in the gym on a strict conditioning only regimen since two weeks before the boot (going on 5 weeks). Strap bar, and core/arm strength only.
I'm calling the dr again Monday morning, just looking for any insight I can get before then.
Thanks!!
 
For my daughter, the only thing that really worked (and we tried a *long* list of things) was 5 weeks out of the gym doing nothing. She still gets twinges from time to time, but we hit them with ice and a blast of anti-inflammatory cream, and they're better by the morning.
 
I'm keeping her out this week, darn Doctor still hasn't called back!! I called 3 times yesterday, always told by the automated system that there were 9 callers ahead of me, left 2 voicemails, with no call back. Looking for a new dr now.
 
Does you insurance require a doctor's referral for PT? Many don't. I would see if you can skip the 2nd opinion and get her in with a PT instead.
 
Was this you ped or a sport med dr? Usually you will need an order for PT, but your reg pedi may order it for you w/o a visit. If you've been calling your pedi, then call a sport med doc (I bet you have one since you got a boot...boots seem to be the answer to everything right now...sigh)
For severe's it is an agpophysitis where the achilles hit the calcaneus (heel bone) and irritated the growth plate there. Here is a picture (I hope this works)
http://www.footvitals.com/wp-content/uploads/2014/01/31_Severs-Disease-300x231.jpg

So there are a couple important pieces for this and most people use some combo of these
1. rest
2. achilles stretching (her toe walking is a huge indicator that there is trouble here)
3. antiinflammatory (ice, nasals)
4. heel lift/heel cup/nxtmile inserts in shoes/cheetah cups...never barefoot in a tennis shoe with insert (and not something from the Dr. sholl's stand in the store) unless in bed or shower. as improvement happens with stretching/PT then can move to gym in her shoe/insert, then to tennis shoes all the time except gym...
These kids show avoid flip flops, ugg boots, barefoot, sperrey's, ballet flats etc...really for a few years until they are closer to post pubertal height.
5. PT is essential for stretching the achilles if "conservative" measures don't work or if you are "in season" or even just a competitive athlete PT should really be involved from the beginning. You can imagine that all the rest in the world isn't going to fix the tight achilles that is pulling on the apophyseal plate...


Not sure if this helps, but I'd get a sport med doc (a new one) and PT asap. They may also X-ray which is not normally needed to diagnose this, but since after weeks and weeks in a boot she is no better and is having pains that awaken her. (night pain is rarely a good sign) - there is a (benign) tumor called osteoid osteoma that is typically in the tibia (lower leg bone) that is known for night pain/night awakening. (it would show on X-ray) I worry a little that her pain is as proximal as her knee at times.
 

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