Sever’s Disease Care for Active Kids

Understanding Sever’s Disease

Learn what causes heel pain in children and how our pediatric care can help.

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 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. Overuse and stress on the heel bone through sports are a major cause, and children 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.

If your child is showing these symptoms, do not hesitate to call us or request an appointment online so we can evaluate the heel and start an effective treatment plan.

Treatment and Prevention Options

To diagnose the cause of your child’s heel pain and rule out other more serious conditions, your doctor will obtain a thorough medical history and ask questions 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 studies such as MRI, ultrasound, and CT scans, along with laboratory tests, may also be ordered.

Your doctor may select one or more treatment options. The child needs to reduce or stop 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 (ultrasound, electrostimulation, cold laser, ice) are sometimes used to promote healing. 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 supportive shoes appropriate for the child’s activity, limiting wearing of cleated athletic shoes, and avoiding activity beyond a child’s ability.

Often, calcaneal apophysitis returns after it has been treated because the heel bone is still growing. If your child has a repeat bout of heel pain, make an appointment with your foot specialist so we can reassess and adjust the plan.