Definition Osgood-Schlatter disease is a condition in children that causes pain just below the knee. Sever disease is a condition in children that results in pain at the back of the heel.
What is going on in the body? In children, the shin and thigh bones, which are known as the long bones of the legs, grow longer from the ends of the bones. These growing areas are called epiphyses. Tendons attach to the bones close to these growing ends. When the bones are very actively growing, vigorous exercise can cause the tendons to pull on the epiphyses. This can lead to irritation and swelling and can even interfere with the growth of the bone. When the swelling and pain occur just below the knee, it is known as Osgood-Schlatter disease. When the swelling and pain occur at the heel, it is called Sever disease. Both conditions occur most often in children between the ages of 10 and 15 years. Sever disease sometimes occurs in children as young as 8. Both conditions occur more often in very active children and affect boys slightly more often than girls.
What are the signs and symptoms of the disease? The symptoms of Osgood-Schlatter disease and Sever disease are similar, and include:
a firm, painful swelling on the front of the leg just below the knee (Osgood-Schlatter disease)
pain and swelling at the back of the heel (Sever disease)
pain that comes and goes
pain that is worse when kneeling, running, or jumping
The pain can be so bad that the child may have to give up sports for a while. Usually only one knee or heel is involved, although it can occur in both.
What are the causes and risks of the disease? A child between the ages of 10 and 15 years is at risk for developing these conditions if he or she is very active and plays sports that involve running, jumping, and stretching of the muscles in the lower legs.
What can be done to prevent the disease? There is no way to prevent these conditions in a growing, active child. Sports safety guidelines can be followed to minimise pain.
How is the disease diagnosed? These conditions are diagnosed by the physical symptoms and signs in a very active child. In most cases, x-rays or blood tests are not necessary unless a child has unusual signs or symptoms. These may include fever, pain that is getting worse, pain at rest, or pain that awakens the child in the middle of the night.
What are the long-term effects of the disease? A child who has either of these conditions will usually outgrow it in a year or two. There is no long-term disability associated with either condition.
What are the treatments for the disease? Treatment involves resting the area to allow it to heal. This means avoiding activities that cause pain in the knee or heel, such as kneeling, jumping, or running. Usually a splint or cast is not necessary, unless the pain is so severe that the child cannot walk. In this case, the child should be checked to see if something else is causing the pain. Applying an ice pack to the affected area may help. Non-steroidal anti-inflammatory medications such as ibuprofen can help, too. In Osgood-Schlatter disease, wearing an elastic pad over the knee may prevent further irritation to the knee. In Sever disease, raising the heel of the shoe 1/4 to 1/2 inch will decrease the pull of the tendon on the heel while walking. Rarely in Osgood-Schlatter disease, the fragmented ends of the growing bones may not heal after the tips of the bones have fused. The condition may continue to be painful. In this case, the fragment may be removed in surgery.
What happens after treatment for the disease? Non-steroidal anti-inflammatory medications may cause stomach upset or allergic reaction. If surgery is necessary there are risks for stomach upset and allergic reaction to the anaesthesia. There is also a potential for infection from the surgical opening.
How is the disease monitored? Osgood-Schlatter and Sever diseases are common problems that affect 10 to 20 percent of young athletes. Neither condition will cause any long lasting damage. If the pain is tolerable, the child can continue to play sports, as long as he or she:
avoids direct trauma to the painful area
uses padding during activities
gives the affected area time to rest between activities
Most cases of Osgood-Schlatter or Sever diseases will get better in a year or two without treatment.
Author: John Wegmann, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
