Physical Therapy Diagnostic Process in Patients with Sever’s Disease and Bilateral Heel Pain: A Case Report

Background: Heel pain in developing children can be challenging to diagnose within the physical therapy clinic. A comprehensive subjective history and through physical examination are pivotal factors to properly identifying an individual with Sever’s disease. The utilization of special tests like the medial-lateral squeeze test and passive straight leg raise test provide valuable information for individuals of this patient population. Case Description: A 12-year-old basketball/luge athlete that presented to the clinic with bilateral heel pain which worsened with running and jumping activities. The patient presented hypermobility through his trunk and lower extremities along with excessive posterior musculature tightness spanning from his low back down to his heels. The individual expressed significant pain with the squeeze test of his Achilles tendon and stood with pes planus and significant in-toeing. Purpose: The purpose of this case report was to demonstrate a detailed diagnostic process in patients with Sever’s Disease and bilateral heel pain. Outcome Measures: By the final visit, the patient reported resolution of his bilateral heel pain and improved functional activity tolerance as measured through the lower extremity functional scale. His interventions consisted of extensive soft tissue mobilization, balance drills, and core strengthening exercises to address his posterior musculature tightness and lack of passive stability in his hips, knees, and ankles. Discussion: The diagnosis process goes beyond addressing the local complications of a patient. One must consider adjacent joints and structures in order to develop a global picture of the individual and identify the potential overarching source of the patient’s dysfunction.