Sever’s Disease Care for Active Kids

Understanding Sever’s Disease

Learn what causes your child’s heel pain and how our team approaches diagnosis and care.

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 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 walking, pediatric heel pain generally doesn’t improve in this manner. In fact, walking typically makes the pain worse.

To diagnose the cause of the 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, CT scans, and laboratory tests may also be ordered. If your child is showing signs of Sever’s disease, schedule a visit so we can develop a treatment plan tailored to their needs.

Treatment, Prevention, and Recurrence

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. 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. The child needs to reduce or stop any activity that causes pain. Temporary shoe inserts, heel cups, or custom orthotic devices may support the heel. NSAIDs, such as ibuprofen, help reduce pain and inflammation. Stretching or physical therapy modalities including ultrasound, electrostimulation, cold laser, and ice may promote healing. In severe cases, a cast may be used to keep the foot and ankle 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 wear of cleated athletic shoes, and avoiding activity beyond a child’s ability. Sever’s disease can return because the heel bone is still growing, so if your child has a repeat bout of heel pain, be sure to make an appointment with your foot specialist for evaluation.