Sever’s disease is the most common cause of heel pain in children and adolescents, especially those who play sport or are particularly active. Sever’s disease occurs when the growth plate at the back of the heel bone becomes aggravated and painful.
Any parent will attest that sometimes it seems like their kids go to bed one night and wake up the next day taller! Children’s bones are still growing, including the bones in their feet and legs. This growth comes from an area of the bone called the growth plate. Until these growth plates close (ossify), the area is susceptible to inflammation, leading to pain. Inflammation of the growth plate is called apophysitis and Sever’s disease is an apophysitis of the heel bone (calcaneus).
Kids are particularly vulnerable to Sever’s disease due to the increased rate of growth in the leg bones leading to tightness of the calf and increased pull on the Achilles tendon and growth plate.
Your child will be more likely to develop Sever’s if:
– They are or have recently experienced a growth spurt
– They are physically active
– They participate in sports such as soccer or football
– They wear unsupportive footwear
– They have tight calf muscles
– They are between the age of 8 and 13
Severs disease will usually involve a combination of the following:
– Pain in the heel during and following physical activity
– Tenderness at the bottom of the calf muscle, along the Achilles tendon
– Tip-toeing to avoid placing load on the heel during walking or running
– Tenderness or stiffness in the heel or leg after sleeping
– Limping, particularly after activity
– Swelling or redness around the back of the heel
Podiatrists at Erko Podiatry diagnose Sever’s disease based on taking a thorough history of the injury and a complete clinical and biomechanical assessment. This will involve:
– Checking of joints and muscles
– Footwear assessment
– Observation of walking (gait analysis)
How to treat Sever's Disease?
After a consultation with your podiatrist a treatment plan will be developed for you. Treatment for this condition may involve:
– Activity modification – reduce activities that aggravate the growth plate such as running and jumping
– Supportive footwear – shoes with a rearfoot to forefoot drop and with adequate shock absorption to assist in managing Achilles load
– Manual therapy / massage to address tightness and reduce load at the Achilles tendon and heel
– Calf stretches addresses tightness and reduce load at the Achilles tendon and heel
– Orthotics to correct biomechanical issues that can assist in decreasing pain and deflecting pressure away from the area of pain
– Heel raises to decrease pressure and tension on the growth plate by raising the heel and calf.
– Ice helps to reduce inflammation and discomfort
Sever’s disease may flare during periods of increased growth and physical activity and then ease somewhat during quieter periods. The condition will permanently resolve when the growth plate in the child’s heel bone closes, usually around 13-15 years of age.
We recommend a decrease in the amount or intensity of activity until symptoms resolve. It is important that normal sport and activities are not continued if symptoms are being experienced as this may lead to significant damage and bony changes at the growth plate.
Sever’s disease is the common name for calcaneal apophysitis. Apophysitis is an inflammation at or around a growth plate and can occur at various points around the body where growth plates are still open. ‘Calcaneal’ refers to the calcaneus or heel bone.