What is Sever’s Disease?

Sever's Disease (Calcaneal Apophysitis) is a painful condition of the heel that develops in children with the damage of the growth plate at the back of the heel where the achilles tendon attaches to the heel bone. It is most common in active children aged 8-14 years. At this age the growth plate is open and active as the foot is growing and can be easily damaged. At this age the long bones of the leg are also growing quickly. This can make the muscles of the leg, particularly the calf muscle, become much tighter than is ideal.

Symptoms of Sever’s disease

Heel pain in children is usually located at the back or the side of the heel bone, and will often be very painful when the sides of the heel are squeezed. The calf muscles may also feel tight and it may be uncomfortable to stretch them. In severe cases a limp may be evident and the pain from this condition will greatly restrict activity.

Causes of Sever’s disease in children

The achilles tendon is a powerful tendon which attaches to the growth plate in the back of the heel. The repetitive tensile force that is applied to this attachment during exercise creates traction on the growth plate. The growth plate is then damaged, can become irritated and inflamed and this will cause pain.

Abnormal or poor foot position (excessive pronation or supination) can exacerbate heel pain leaving some children more susceptible to this condition than others. Intense activities in bare feet or running on hard surfaces and tight calf muscles are also contributing factors to heel pain in children

Treatment for Sever’s disease

If your child has Sever's disease it is a good idea to limit their activity level until the symptoms have reduced which can be weeks or even months. A cushioned heel raise (approx 8-15mm) is a very effective intervention as it relieves the tensile strain from the achilles tendon at its attachment to the injured growth plate.

A good pair of running shoes is very important. It is wise to avoid walking and running barefooted while the heel is painful. Applying ice to the heel for 20 minutes at a time will help to relive the pain, particularly after activity. Light stretching of the calf muscle and achilles tendon is also advised provided that it does not aggravate the injury and increase the pain.

If the pain does not subside with these simple measures, our podiatrist will be able to help with the use of supportive strapping during activity and may recommend the use of orthotics. Orthotics will help to correct poor foot position and to relieve the strain on the tendon and growth plate. The use of anti-inflammatory medication may also be useful.

It is important to remember that Sever's Disease will only exist while the growth plate is open. This growth plate will usually close once the growth period has ceased, around the age of 17, however this will vary between children. Sever's disease is a self limiting condition. In other words, there are no long term effects to the growth plate or the foot with this injury. It is important however to address a case of Sever's disease early because the pain and inconvenience that it causes the young athlete is upsetting for all. Seek advice from our podiatrist if you are concerned or require further information on Sever's Disease.

If you would like more information on how to treat heel pain in children (Sever’s Disease), please contact our Brunswick or Sandringham Foot Clinics for more information.