Sever’s Disease Care for Active Kids

Understanding Sever’s Disease

What parents should know about calcaneal apophysitis and pediatric heel pain.

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, 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 can occur in one or both feet. Unlike adult heel pain, which usually subsides after a period of walking, pediatric heel pain generally doesn’t improve that way. 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.

Overuse and stress on the heel bone through sports are a major cause. The growth plate is sensitive to repeated pounding on hard surfaces, so children involved in soccer, track, or basketball are especially vulnerable. Other 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.

If your child is having heel pain, schedule an evaluation so we can pinpoint the cause and start the right treatment.

Diagnosis, Treatment, and Prevention

To diagnose the cause of your child’s heel pain and rule out more serious conditions, your doctor will obtain a thorough medical history and ask about recent activities. Your doctor will also examine the child’s foot and lower leg. X-rays are often used to evaluate this condition. In some cases, advanced imaging such as MRI, ultrasound, and CT scans, as well as laboratory tests, may also be ordered.

Treatment is tailored to each child and may include reducing or stopping 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 such as ultrasound, electrostimulation, cold laser, and ice are sometimes used to promote healing. In severe cases, a cast may be used to keep the foot and ankle immobilized while it heals.

Calcaneal apophysitis often returns after treatment because the heel bone is still growing. Recurrence may signal Sever’s disease again or a different problem, so if your child has a repeat bout of heel pain, make an appointment with your foot specialist.

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

With the right care plan, most children return to full activity as the growth plate matures.