Many young kids that participate in sports can have complaints of pain in their heels. This is more common in children who are actively growing and those who are very active in running and jumping sports. Young gymnasts fall into this category, and they also practice and compete barefoot, which can lead to a higher risk of injury to the foot.
Sever’s disease is inflammation of the growth plate on the back of the heel. It is also called calcaneal apophysitis. The Achilles tendon attaches near this growth plate on the heel. Bones often grow first, and our muscles have to stretch to accommodate this new bone length. This can lead to tightness in our muscles. If the Achilles tendon is tight, the repetitive pulling during jumping and running can lead to irritation of the growth plate in the heel. The Achilles tendon is comprised of the two muscles in our calf, the gastrocnemius, and the soleus muscles.
Activity Modification: Rest is one of the first recommendations for children with Sever’s disease. Limiting the amount of running and jumping activities or even stopping an activity for a short period can be helpful to calm down the irritation to the heel. RICE (rest, ice, compression, and elevation) is also a common recommendation for treatment for the symptoms of Sever’s disease. As physical therapists, our goal is to return our patients to their desired activities as quickly as possible; sometimes, this means stopping all activities for a short period to jump-start the rehabilitation process.
Other modifications for gymnasts include using soft mats for landing and limiting the number of repetitions for running and jumping skills. Gymnasts should also be encouraged to wear supportive tennis shoes at school and home rather than being barefoot. A more supportive shoe can also protect the tender area over the heel during the gymnast’s daily tasks.
Wear a brace: Several braces can be helpful to manage the symptoms of sever’s disease including a heel cup, X-brace, or Tuli’s cheetah heel protector. These provide more cushioning over the heel area when the athlete is barefoot at practice or competition.
Stretches: Frequent calf stretching can help manage the pain from Sever’s disease. Gymnasts should focus on stretching both muscles in the calves, as mentioned above.
Strengthening: Strengthening the entire lower body can also help manage the pressure placed through the heels by improving overall mechanics during gymnastic skills. Gymnasts should have a strengthening program focusing on the core, hips, knees, and foot and ankle. Some examples of exercises gymnasts can be found below:
Resisted hip kicks: Place a resistance band around your ankles.
Physical therapy can help establish a good strengthening program for gymnasts to address their symptoms and areas of weakness.
For more information about the benefits of strengthening the foot, click here to refer to our previous barefoot strengthening for gymnast blog.
If pain is not improving or pain is worsening, it is important that you receive further evaluation by setting up a free assessment at your nearest Athletico. Pushing through pain can potentially lead to damage of the growth plate and subsequently more time out of gymnastics. If you are looking for a more individualized program for a gymnastics injury, you can find an Athletico gymnastics program member near you today.
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