Sever's Disease Sever’s Disease

Although the name sounds frightening, Sever's disease is a fairly common heel injury that occurs in kids. It can be painful, but is only temporary and has no long-term effects.

Sever’s disease (also called calcaneal apophysitis) is a painful bone disorder that results from the inflammation of the growth plate in the heel. The growth plate is an area at the end of a developing bone where cartilage cells change over time into bone cells. As this occurs, the growth plates expand and unite. This is how bones grow.

Sever’s disease is a very common cause of heel pain in kids, especially those who are physically active. It usually occurs during early puberty when kids grown most rapidly. This growth spurt can begin any time between the ages of 8 and 13 for girls and 10 and 15 for boys. Sever's disease rarely occurs in older teens because the back of the heel usually finishes growing by the age of 15, when the growth plate hardens and the growing bones fuse together into mature bone.

Causes of Sever’s Disease

When a child goes through a growth spurt during puberty, the heel bone (calcaneus) sometimes grows faster than the leg muscles and tendons. This can cause the muscles and tendons to become very tight and overstretched, making the heels less flexible and putting pressure on the growth plate. Over time, repeated stress on heel cord (also called the Achilles tendon) damages the growth plate, causing swelling, tenderness, and pain.

This tendon stress commonly results from physical activities and sports that involve running and jumping, especially those that take place on hard surfaces, such as track, basketball, soccer, and gymnastics.

Sever's disease also can result from standing too long. Standing puts constant pressure on the heel. Poor-fitting shoes can contribute to the condition by not providing enough support or padding for the feet or by rubbing against the back of the heel.

Here are some conditions that increase the likelihood that a child will develop Sever’s disease:

  • A pronated foot (a food that rolls in at the ankle when walking) can cause tightness and twisting of the Achilles tending. This increases the pull on the heel’s growth plate.
  • Flat or high arches can affect the angle of the heel within the foot, causing tightness and shortening of the Achilles tendon (see Pediatric Flatfoot*)
  • Short leg syndrome (where one leg is shorter than the other) can cause the foot on the short leg to bend downward to reach the ground. This pulls on the Achilles tendon.
  • Being overweight or obese puts weight-related pressure on the growth plate.

Sever’s Disease Symptoms

The most common sign of Sever's disease in a child is pain or tenderness in one or both heels. The pain is usually at the back of the heel, but might extend to the sides and bottom, ending near the arch of the foot.

Some other outward symptoms of Sever’s disease:

  • Swelling and redness in the heel
  • Difficulty walking
  • Discomfort or stiffness in the feet upon waking up in the morning
  • Discomfort when the heel is squeezed on both sides
  • An unusual walk, such as walking with a limp or on tiptoes to avoid putting pressure on the heel

Symptoms are usually worse during or after activity and get better with rest.

Sever’s Disease Treatment

The main treatment for Sever’s disease is rest, since symptoms generally worsen with activity. Resting the foot helps to relieve pressure on the heel bone which decreases swelling and reduces pain. Try to have the child cut down on activities that cause pain until all symptoms are gone. This may include running barefoot or on hard surfaces since the impact can worsen pain and inflammation.

Your podiatrist may also recommend the following:

  • Have the child perform foot and leg exercises to stretch and strengthen the leg muscles and tendons.
  • Elevate and apply ice (wrapped in a towel, not applied directly to the skin) to the injured heel for 20 minutes two or three times per day, even on days when the pain is not that bad, to help reduce swelling.
  • Use an elastic wrap or compression stocking that is designed to help decrease pain and swelling.
  • Give the child an over-the-counter medicine to reduce pain and swelling, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)

In very severe cases, your podiatrist may recommend that the child wear a cast for anywhere from 2 to 12 weeks to immobilize the foot so that it can heal properly.

With proper care, Sever’s disease usually goes away within 2 weeks to 2 months, and does not cause any problems later in life. The sooner Sever's disease is addressed, the quicker recovery is. Most kids can return to physical activity without any trouble once the pain and other symptoms go away.