Sever disease of the heel (also known as calcaneal apophysitis) is one of the most common causes of heel pain in active children and adolescents. It is caused by repetitive impact stress on the growth plate of the heel bone, particularly in sports that involve running and jumping. Children with flat feet or high arches and tight calf muscles are at risk.
Symptoms
Often children who participate in high impact activities such as running and jumping experience pain in the back of their heel. The cause is repetitive stress that causes the growth plate in the heel to become irritated, tender and sore. This overuse injury can occur in children between the ages of 7 and 14, particularly during growth spurts.
During growth spurts, bones grow faster than muscles and tendons, which can lead to tightness in the Achilles tendon. The repeated stress of sports can then put too much pressure on the heel bone’s growth plate and cause inflammation. The heel bone’s growth plate is also softer than the surrounding hard bones, making it more sensitive to pressure.
The most common symptoms of Sever’s disease are painful, tender and swollen heels. The pain usually occurs during and after sports, especially high impact activities such as running and jumping. Other symptoms include difficulty walking or climbing stairs and a stiff, tight feeling in the back of the heel.
Usually children with Sever’s disease recover within a few weeks to 2 months and can return to all their previous sports and activities without any lasting problems. However, it is not unusual for the condition to recur. Keeping the heel and ankle properly stretched, using soft orthotic inserts to distribute and cushion the pressure on the calcaneus and wearing shoes with good support decreases the risk of developing this condition again in the future.
Diagnosis
Sever’s disease (also known as calcaneal apophysitis) develops when repetitive stress on the growth plate of the heel causes it to become inflamed. This condition is commonly found in active children and adolescents between the ages of 8 and 15 especially those participating in football, basketball, soccer, netball, tennis, gymnastics and other sports that involve running and jumping.
The repeated stress of these sports can cause the Achilles tendon to tighten pulling on the growth plate and causing it to become inflamed. The pain in the back of the heel can be felt during and after exercise especially when there is a lot of running or jumping. Pain is also elicited when there is pressure applied to the area.
To diagnose this condition, the doctor will do a physical examination of the foot and leg and may recommend a squeeze test. This test is done by pressing down on the back of the heel to see if there is pain.
Treatment of this condition involves resting the heel from the activities that cause it. Ice applications can help reduce the swelling and inflammation. Over the counter pain medicines such as ibuprofen or acetaminophen can be used to control the pain and swelling. Increasing the amount of stretching exercises to lengthen the Achilles tendon can decrease the stress on the heel and aid in the healing process. If the symptoms do not improve with rest, a visit to your healthcare provider may be necessary for further evaluation.
Treatment
Sever disease, also known as calcaneal apophysitis, is one of the most common causes of heel pain in young, active children. It typically affects children between the ages of 8 and 15 who participate in running or jumping sports like football, soccer, basketball, netball, tennis and gymnastics. This overuse injury can be quite painful but typically resolves as the growth plate in the heel matures.
Diagnosing Sever disease involves a physical examination of the heel by your healthcare provider. They will look for swelling, tenderness and assess your child’s activity level. X-rays are rarely used to diagnose Sever disease but can be ordered to rule out other problems.
Reducing or stopping activities that cause pain is the best way to allow your child’s heel to heal. This may include avoiding running or jumping until the pain subsides. Using ice several times a day for 15-20 minutes can help decrease inflammation and relieve pain. Using a heel cup or supportive shoe inserts can also help reduce the stress on the heel.
Stretching exercises can help to increase flexibility of the calf muscles and Achilles tendon which can decrease the tightness and pressure that leads to Sever disease. Your healthcare provider will be able to teach you some of these exercises.
Prevention
Sever disease is caused by repetitive stress on the calcaneus (heel bone) growth area, which occurs when a child has a vigorous athletic lifestyle and experiences a rapid increase in exercise activity. The heel bone grows more quickly than the muscles, tendons and ligaments attached to it, which causes them to tighten and pull on the back of the foot and ankle. This leads to inflammation and pain in the apophysis of the heel.
Kids who play sports that require running and jumping, such as basketball, soccer or track, are more likely to experience this condition. The heel growth plate is also more irritated when it is subjected to sudden or increased stress, such as starting a new sport season, or returning to activity after a long break.
The best treatment options are to avoid excessive impact activities, use ice to decrease pain and swelling and to stretch the calf muscles and tendons of the back of the leg. It is recommended that a physical therapist be consulted to provide a specific home exercise program to improve the stretching and strengthening of the foot and ankle. Heel cups or inner shoe heel lifts can also help reduce the pressure on the back of the heel.
Most children recover from Sever disease with simple home care, rest and proper footwear. If your child’s pain does not improve with at-home treatments, it is important to visit a doctor for a comprehensive evaluation.