Heel Pain in Children: Managing Sever’s Disease

What is Sever’s Disease?
Sever’s disease, also known as calcaneal apophysitis, is a very common cause of heel pain in children and adolescent athletes. Sever’s Disease is an osteochondrosis caused by overload. The growth plate at the calcaneus (heel bone) becomes inflamed secondary to repetitive traction stress of the Achilles tendon.

Sever’s is most common between the ages of 8-14 years of age, especially during a period of rapid growth, combined with a high level of sporting activity. It is more common in sports that involve running, twisting and jumping, such as basketball, football and gymnastics.

What symptoms can children have?

• Pain at the back or bottom of the heel.
• Walking on toes.
• Pain when contracting the calf against resistance.
• Tenderness and pain becoming worse during and/or after exercise.

Risk factors:

• High physical and sporting activities, especially those involving repetitive running and jumping
• Weak ankle dorsiflexors
• Weak or tight calf muscles
• Biomechanical factors such as genu varum or pes planus
• Poorly fitting/overused footwear
• Running on hard surfaces

What are the treatment options?

Sever’s disease often resolves by itself with time. However, the heel may remain uncomfortable for around two to three years until the growth spurt finishes.

Treatment options may include:

• Sufficient rest to ease the symptoms. Relative rest is essential, often a modified training regime is sufficient. Persistent painful activities will only worsen symptoms & prolong recovery.
• Frequent use of icepacks to reduce the swelling and pain.
• Strengthening exercises of the calf muscles/addressing other strength deficits.
• Use of aids- taping or cushioned heel cups placed in the shoes.
• Correction of any biomechanical issues that have been identified by your physiotherapist, which may cause the condition to become worse.
• Very rarely, a walking boot may be used if the condition is severe enough or has persisted for an extended period.

Physiotherapy Provides Rehabilitation and Support

If the pain in your heel or child’s heel that you are managing yourself has not improved after a few days, it is best to seek advice and consult with one of the physiotherapists at Jubilee Sports Physiotherapy to get an accurate diagnosis.  It is important to ensure that Sever’s disease is the actual diagnosis. Other sources of heel or calf pain require different treatment.

Contact one of our physiotherapists for advice on an appropriate exercise program and suggest the most appropriate treatment plan.