Sever’s Disease Care for Active Kids

What You Need To Know

Understanding Sever’s Disease and how it affects your growing child.

Understanding Sever’s Disease in Children

Calcaneal Apophysitis is a painful inflammation of the growth plate in the back of the heel bone (calcaneus). It typically affects children between the ages of 8 and 14, because the calcaneus is not fully developed until at least age 14. Until the growth plate (physis) closes, new bone is forming in this area and makes it weaker than the solid, adjacent bone of the calcaneus. When there is too much repetitive stress on the growth plate, inflammation can develop.

Calcaneal apophysitis is also known as Sever’s Disease. It is the most common cause of heel pain in children, and it can occur in one or both feet. Heel pain in children differs from the most common type of heel pain experienced by adults. While heel pain in adults usually subsides after a period of walking, pediatric heel pain generally doesn’t improve in this manner. In fact, walking typically makes the pain worse.

Symptoms may include pain in the back or bottom of the heel, limping, walking on toes to avoid pressure to the heel, difficulty running or jumping, pain when the sides of the heel are squeezed, and fatigue. Overuse and stress on the heel bone through sports participation is a major cause, and children involved in soccer, track, or basketball are especially vulnerable. Other contributors include obesity, a tight Achilles tendon, and biomechanical problems such as flatfoot or a high-arched foot.

If your child is experiencing persistent heel pain, contact us for an accurate diagnosis and an effective treatment plan.

Treatment, Prevention, and Recovery

To diagnose the cause of your child’s heel pain and rule out other more serious conditions, your doctor will obtain a thorough medical history and ask questions about recent activities. Your doctor will also examine the child’s foot and lower leg. X-rays are often used to evaluate this condition, and in some cases advanced imaging studies such as MRI, ultrasound, or CT scans may also be ordered. The podiatrist may perform a squeeze test, where gentle pressure is applied to both sides of the heel to check for pain and tenderness.

Treatment focuses on relieving pain, reducing inflammation, and preventing further irritation. Your doctor may recommend reducing activity, temporary shoe inserts, heel cups, or custom orthotic devices to support the heel. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation. Stretching and physical therapy modalities such as ultrasound, electrostimulation, cold laser, and ice are sometimes used to promote healing. In severe cases, a cast may be used to keep the foot and ankle immobilized.

The chances of a child developing heel pain can be reduced by avoiding obesity, choosing supportive shoes appropriate for the child’s activity, limiting cleated athletic shoes, and avoiding activity beyond a child’s ability. Encourage stretching before and after activities and gradual increases in training intensity.

Because the heel bone is still growing, calcaneal apophysitis can return after treatment. If your child has a repeat bout of heel pain, schedule a follow-up with your foot specialist so care can continue as your child grows.