Sever’s disease, known as calcaneal apophysitis, is the most common cause of heel pain in children. It’s a painful bone disorder created by inflammation of the growth plate in the heel, usually from muscle strain and repetitive stress. Sever’s Disease is very common in obese children and those who play lots of sports, and most commonly occurs during growth spurts in adolescence. For girls, this is usually between 8 and 13 years of age, and for boys, between 10 and 15.
The heel is especially susceptible to injury in children. The foot is one of the first parts of the body to grow to full size and the heel area is not very flexible. The growth plate is a soft area at the end of the heel bone where cartilage cells change into bone cells, and it eventually fuses with the heel bone.
During the early part of puberty, the heel bone sometimes grows faster than the leg muscles and the Achilles tendon, which attaches the calf to the heel bone. When this unequal growth occurs, the muscles and tendons become very tight, which makes the heel less flexible, placing a lot of stress on the growth plate. The Achilles tendon, when stretched too tightly, becomes swollen, tender, and painful where it attaches to the growth plate. This injury, a result of repetitive stress on the Achilles tendon, is Sever’s Disease.
If a child is active, doing a lot of running, jumping, and playing on hard surfaces, they can put a lot of stress on those too-short muscles and Achilles tendon, resulting in heel pain. Other factors which can contribute are:
- Long periods of standing which put constant pressure on the heel
- Pronated foot (a foot that rolls inward when walking). Pronation tightens and twists the Achilles tendon and pulls on the growth plate
- Flat feet or a high arch. This again cause the Achilles to be overstretched
- Short leg syndrome, in which one leg is shorter than the other. This causes the foot on the short leg to bend downward, putting stress on the Achilles
- Obesity – weight puts pressure on the growth plate
Symptoms of Sever’s Disease
- Pain or tenderness in one or both heels. Pain is usually felt at the back of the heel, but may also be felt along the sides and bottom of the heel, all the way to the arch.
- Swelling and redness in the heel
- Feet are stiff upon waking
- Difficulty walking or running
- Child may walk on tiptoes or with a limp to avoid putting pressure on the heel
- Pain may increase with activity
To relieve symptoms
- Rest to relieve pain
- Curtail athletic activities
- Wear athletic shoes that fit properly and provide cushioning
- Ice and elevate the sore foot to reduce swelling
- Stretching exercises for the heel and hamstring
- No high heeled shoes
- Over the counter pain medicine (check with your doctor first)
- If symptoms are caused by obesity, a weight management plan
Sever’s Disease fortunately is a temporary condition. With proper care and treatment, symptoms will usually go away within 2-8 weeks, and it will have no long term consequences. If the condition recurs due to the child having a pronated foot, or a flat or high arch, your podiatrist may recommend custom orthotics to position the foot correctly inside the shoe and reduce stress on the heel.
The risk of recurrence of Sever’s Disease diminishes with age, and as a rule won’t occur after the age of 15. By that time, foot growth is complete and the growth plate has fused to the rest of the heel bone.