What Is Sever’s Disease?

Sever’s disease is a condition that occurs when the Achilles tendon ends up pulling on the growth plate of the heel bone. This repeated stress on the growth plate of the heel can lead to pain and inflammation, making movements like standing, walking and running quite uncomfortable. It tends to occur in physically active children between the ages of 8 and 14 years old, and discomfort typically increases during physical activity or a period of rapid growth. During a growth spurt, the bones grow faster than the tendons, increasing the pull of the tendon on the heel.

Aside from heel pain that comes and goes and may be worsened by activity, other symptoms of Sever’s disease include:

• Limping
• Walking on toes to avoid pressure on the heels
• A feeling of pressure on the back of the heel
• Swelling
• Redness

And while Sever’s disease is not all that serious, try telling that to a kid who just wants to run around with their friends without pain, or to a parent who wants to help their child find relief from their discomfort. Fortunately, with targeted treatment, many children and teens can find the pain relief they seek.

How To Treat Sever’s Disease

Treatment is pretty simple on paper, but every parent knows that it’s not always easy to get kids to follow through with commitments like physical therapy or to adhere to restrictions that have been put in place. It will take a concentrated effort from both parent and child to help them successfully overcome this condition. Odds are your foot specialist will recommend a combination of the following treatments:

Rest/Activity Avoidance – You’ll want to cut back a little on activities to provide a better healing environment for the tendon and heel. That’s not to say that children should just sit on the couch for weeks, but limit physical activities that include tasks like running and jumping, especially if symptoms start to develop.

Ice – Icing the back of the heel and the lower Achilles tendon for 15-20 minutes after activity or when symptoms develop can help to calm inflammation and swelling that could be prolonging discomfort.

Footwear Changes – Cushioned and supportive shoes are a must. Shoes that are too tight or unsupportive options can put more strain on the Achilles tendon and in turn the heel.

OTC Pain Relievers – Over-the-counter pain relievers and anti-inflammatory medications may also prove useful for calming irritation caused by activity.

Physical Therapy and Stretching – Stretching and physical therapy exercises are very important in helping your child find long-term pain relief. Stretching will help to loosen a tight Achilles tendon to decrease the pull of the tendon on the growth plate. Calf stretches through toe pointing or flexing, or by stretching up against a wall can help to take pressure off the heel’s growth plate.

The post Heel Pain In Children – What Could Be The Cause? appeared first on Lance Silverman, MD - Orthopedic Foot & Ankle Surgeon.

Medical professionals reviewed cases of pediatric exposure to prescription drugs over a 10-year period.  They found anti-diabetes medication and beta-blockers were the most common drugs taken orally that resulted in a visit to the Emergency Department, representing 60.3% and 59.6% of cases respectively.  Researchers also noted the exposure to opioids resulted in a serious injury 26.3% of the time, while ingestion of hypoglycemics did so 19.5% of the time.

The data was analyzed in hopes of determining if there was a casual relationship between the rise in adult prescription drugs and pediatric poisonings.  Over 70,000 children in the United States are hospitalized each year for suspected accidental poisoning.

To combat the rise in pediatric exposure, researchers placed children into three different groups to analyze the likelihood of consuming certain prescription drugs based on their age.  The three groups included:

• Children between the ages of 0-5
• Children between the ages of 6-12
• Children between the ages of 13-19

For simplicity’s sake, researchers limited their data to Emergency Department visits that occurred from ingesting one of four common drug classes; opioids, beta-blockers, lipid-lowering medications, and oral-hypoglycemics.

Findings

During their 10-year study that analyzed data from 2000 to 2009, officials discovered there were:

• 62,416 cases of pediatric exposure to opioids
• 49,075 cases of pediatric exposure to beta-blockers
• 39,693 cases of pediatric exposure to lipid-lowering medications
• 38,485 cases of pediatric exposure to oral hypoglycemic

The study also found that all cases showed an increase in exposure likelihood as the child got older.  For a children 5 years old or younger, ingestion rates of opioids increased each month by 0.09 per million, while teens between the ages of 13 and 19 saw a monthly increase of 0.04 per million.

When looking at the correlation between adult use and pediatric exposure, researchers noted that for every 1% increase in the number of adults with prescriptions for opioids, there was an increase of 1.53 poisonings per million children aged 5 and under, and a 0.74 per million increase in teens between the ages of 13 and 19.  Similar results were seen when researchers examined a 1% increase in adult prescriptions of beta-blockers, lipid-lowering medications and hypoglycemics.

Despite the development of a child-safety lock and the recommendation that prescriptions be kept out of the reach of children, thousands of kids are rushed to the ER each year after an accidental exposure.  Researchers said poisonings were most common in the first month after a prescription was given or renewed, so take precautions each time you bring home a full bottle of prescription pills.

Dr. Silverman comments

This unfortunate trend is alarming, but can we really be that surprised?

The rise in opioid use has made mood-altering drugs readily available. These drugs can depress respiration and kill. The obesity trend has created the rise in diabetic medications, meaning more drugs are in homes than ever before.

It only makes sense that the more children who have access to their parents’ drugs, the greater the likelihood for tragedy. Despite the actions of pill bottle makers, the kids are getting to them because the adults don’t stop them.

Children need to understand the medicine cabinet holds dangerous items. People need to treat all medication like they treat firearms, because they can be just as deadly.

Related source: MedPage Today

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Background

Dietary supplement use among teens is becoming increasingly popular.  One estimate suggests that 70% of youth under age 18 have consumed dietary supplements at least once, with the majority seeking improved performance in sports.  Marketers have caught on, and they use words like muscle mass, speed and agility to entice teens.  Below are some ways marketers advertise their products to teens.

• Agents used for weight gain, including over-the-counter products are advertised as “muscle mass enhancers”.
• Supplements used for weight control, including stimulants, diet pills, diuretics, and laxatives are targeted as “lean and fit” products for athletes who need to meet certain weight classifications.
• Powders or other pills that support muscle growth are said to “regenerate muscles to boost performance”.

With high school sport participation at an all time high, researchers hoped to note the physical and mental health effects certain dietary supplements had on young athletes.  The aim of the study was to assess self-reported use of dietary supplements to enhance athletic and sport performance among children and teens.

Method

The Center for Disease Control and Protection defines adolescents as those aged 10–24 years, so the sample included children between the age of 10-18, and adolescents between the ages of 18-24. The variables retained included socio-demographic variables such as age, gender, race/ethnicity, geographic location, and citizenship status of the respondents; parental presence in the family; parental level of education; parental use of sport enhancement, herbal, vitamin/mineral supplements; and use of any herb, vitamin, and/or mineral for sports performance by these children.

The study asked participants or their parents whether the adolescent had “improved their sport performance” within the past 30 days by taking either a vitamin or other substance for the purpose of “enhancing sport performance.”

Results

Researchers analyzed 9,417 records, which resulted in a population estimate of over 73.7 million.  Based on their calculations, about 1.2 million (1.64%) children or adolescents reported using some sort of dietary supplement specifically targeted to enhance sport performance, and about the same percentage (1.65%) noted an improvement in their sport performance.

Other findings include:

• The mean age of those reporting the use of supplements was 10.8 years old.
• 72.9% of respondents reported living with both parents.
• Whites were roughly three times more likely to use dietary supplements than blacks, and about five times more likely than Hispanics.
• Males were twice more likely to use sport enhancing dietary supplements than women.
• Coaches were the most likely to recommend and performance enhancing dietary supplement.

Dr. Silverman comments

This study is horrendously non-specific and disappointing.  With 73.7 million children studied, you would think that a few more salient correlations could be identified. The biggest conclusion they came to was that males and whites were more common supplement users.

I was most intrigued by the report that coaches were the most likely to recommend an enhancing substance.

One thing that was misleading was that the authors included the use of any substance that the child believed was a sports enhancement, including vitamins and Omega-3 fatty acids.  They went on to say the mean age was 10.8 years old.  I can’t imagine a better way as a parent to get younger children to take their vitamins than by saying “This will make you big and strong”.  Of course they will report using vitamins as a supplement.

Overall; I was disappointed and was left hoping for so much more. Hopefully follow up studies will be more interesting. We understand a great deal about the long term effects certain supplements have on adults, but we have so little understanding of the long term effects on children.  I can imagine the younger age group being a fascinating population to study.

Related source:  Medscape

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