Sever’s Disease

Heel pain is common in children. While it can occur after a specific injury, it is also commonly caused by Sever’s disease, a type of overuse syndrome, like shin splints or Osgood-Schlatter’s disease.

Children with Sever’s disease, which is also called calcaneal apophysitis, develop inflammation where the Achilles tendon inserts at the calcaneus, or heel bone. This inflammation causes pain, which can vary depending on the type of activity your child is doing, and is generally worse after activity(such as running and jumping) and improves with rest. Sometimes squeezing the heel can cause pain and occasionally it can be felt under the heel.

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Sever's_Disease_X-ray

Sever’s disease is more common in boys and typically occurs when an active child is between 8 and 15 years old. Although it can affect both heels, it more commonly just affects one foot. Sever’s disease is also more common in an excessively pronated foot (a foot rolled in at the ankle) – it is assumed that this may cause an uneven weight bearing on the back part of the heel bone.

TREATMENT

  • Rest or ‘relative’ rest, in which you avoid activities that make the pain worse
  • Cut back on sporting activities – don’t stop, just reduce the amount until symptoms improve (a total break from sport may be needed later).
  • Ice
  • Massage
  • Exercises that stretch and strengthen the Achilles tendon and hamstring and calf muscles
  • Heel lifts or cups
  • Orthotics and footwear
  • Avoid going barefoot
  • If the symptoms are bad enough and not responding to these measures, medication to help with inflammation may be needed.

For severe pain, a short leg cast for 4-6 weeks can be helpful. If the pain isn’t too bad, you might discuss trying the exercises and heel lifts or orthotics first though.

This condition is self limiting – it will cease when the two sections of bony growth join together – a natural process. Unfortunately, Sever’s disease can be very painful and limit sporting activity so treatment is often advised to help relieve it. In a few cases of Sever’s disease, the treatment is not successful and these children will be restricted in their activity levels until the two growth areas join – usually around the age of 16 years.