Sever’s Disease Care for Active Kids

Understanding Sever’s Disease

Learn what causes pediatric heel pain and how we evaluate and treat it.

Pediatric Heel Pain and Sever’s Disease

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 years old, 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 does not 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 on the heel, difficulty running or jumping, pain when the sides of the heel are squeezed, and fatigue.

To diagnose your child’s heel pain and rule out other conditions, your doctor will obtain a medical history, ask about recent activities, and examine the foot and lower leg. X-rays are often used, and in some cases MRI, ultrasound, or CT scans may be ordered. If your child is showing signs of Sever’s disease, schedule a visit so we can confirm the diagnosis and start treatment.

Treatment, Recurrence, and Prevention

Your doctor may select one or more treatment options for calcaneal apophysitis. The child needs to reduce or stop any activity that causes pain. Temporary shoe inserts, heel cups, or custom orthotic devices may provide support for the heel. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation. Stretching or physical therapy modalities (ultrasound, electrostimulation, cold laser, ice) are sometimes used to promote healing. In severe cases, a cast may be used to immobilize the foot and ankle while it heals.

Overuse and stress on the heel bone through sports are a major cause of calcaneal apophysitis. The growth plate is sensitive to repeated running and pounding on hard surfaces, resulting in muscle strain and inflamed tissue. Children involved in soccer, track, or basketball are especially vulnerable. We see a lot of this with soccer players due to the nature of soccer cleat design. Other potential causes include obesity, a tight Achilles tendon, and biomechanical problems such as flatfoot or a high-arched foot.

The chances of a child developing heel pain can be reduced by avoiding obesity, choosing supportive shoes appropriate for the activity, limiting wear of cleated athletic shoes, and avoiding activity beyond a child’s ability.

Often, calcaneal apophysitis returns after treatment because the heel bone is still growing. If your child has a repeat bout of heel pain, make an appointment with your foot specialist so we can re-evaluate and adjust the plan.