Sever’s Disease Care for Active Kids

Understanding Sever’s Disease

A parent’s guide to recognizing and treating heel pain in growing children.

Sever’s Disease (Calcaneal Apophysitis)

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 to the heel, difficulty running or jumping, pain when the sides of the heel are squeezed, and fatigue. If your child is experiencing these symptoms, schedule an appointment so we can evaluate the heel and start the right treatment early.

Causes, Treatment, and Prevention

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

Your doctor may select one or more treatment options. These often begin with reducing or stopping any activity that causes pain, and supporting the heel with temporary shoe inserts, heel cups, or custom orthotic devices. 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 of the inflamed tissue. In severe cases, a cast may be used to keep the foot and ankle totally immobilized.

The chances of a child developing heel pain can be reduced by avoiding obesity, choosing well-constructed supportive shoes appropriate for the child’s activity, limiting wearing of cleated athletic shoes, and avoiding activity beyond a child’s ability. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot specialist so we can guide their recovery.