There are many possible causes of heel pain in children. Sever’s disease, also known as calcaneal apophysitis, is a common cause. This condition commonly occurs in children aged between 10 and 14, and is characterised by pain in one or both heels. This is caused by repetitive damage and inflammation of growth plates of the heel bone (calcaneus). 60% of patients have both heels involved.
The condition is believed to be the result of a mismatch in growth of the calf bone (tibia) to the calf muscle and achilles tendon (the tendon which joins the calf muscle to the heel bone). It is thought that the calf bone grows more quickly than the muscle and achilles tendon and so this soft tissue becomes uncomfortably tight. This places more stress on the immature heel bone which causes inflammation and pain. Altered foot posture can also cause uneven weight bearing on the heel bone which can contribute to Sever’s disease.
Who is most likely to be affected by Sever’s Disease?
Children or adolescents who are having a growth spurt Children aged 5-13 years old
Boys are more likely to be affected than girls.
How is Sever’s disease treated?
There are several steps in the management of this condition.
- ● Activity Modification: limiting sporting activities is essential to decrease the pain. Cutting back on the duration, intensity, and frequency can significantly improve symptoms.
- ● Stretching: posterior muscle group stretches are important to maintain good flexibility (hamstrings & calf muscles). At Feet Street Podiatry we use Pedsol software (www.pedsol.co.uk) – an advanced rehab exercise programme – to assist our patients with this.
- ● Heel cushions/cups or soft orthotics: these can decrease the impact on the heel by distributing and cushioning the weight bearing.
- ● Medication: Use of NSAIDS (non-steroidal anti-inflammatory drugs) such as Ibuprofen (Nuprin, Motrin) or naproxen (Aleve) can decrease pain and secondary swelling.
- ● Physical therapies such as ice or heat: placing cold packs or heat packs onto the painful heel can help to alleviate pain.
- ● Short-leg cast: For very difficult-to-manage symptoms a short-leg cast is occasionally used to force rest the heel.
How long does Sever’s disease last?
Normally this condition lasts 2-3 months. However,in some individuals the symptoms can last longer and can recur over several years.
Are there any long-term problems associated with Sever’s?
To date, no problems have been identified after Sever’s disease has resolved.
How can a podiatrist help?
Your podiatrist can assess the patient to diagnose Sever’s disease and rule out other diagnoses, or decide if onward referral is needed. They can also prescribe a lower limb stretching/ strengthening regime for the patient and heel cups or insoles if appropriate. They can also give advice/prescribe pain management and provide you with guidance on supportive footwear/ activity modifications to support recovery from this condition.
If you are suffering from heel pain, book an appointment with Feet Street Podiatry.