What is Sever’s Disease?

Sever’s disease is a painful inflammation of the growth plate in the heel. Growth plates are areas at the end of children’s bones that undergo changes so bone growth can occur. During this time, the muscles and tendons may not grow as fast as the bone causing tightness and pressure at the back of the heel. With proper treatment, Sever’s disease usually resolves within 2 months with no long term effects on the child.

Sever’s disease, also called calcaneal apophysitis, is a condition causing swelling and pain at the back of the heel that affects growing adolescents. The inflammation occurs at the point where the Achilles tendon attaches to the calcaneus bone, the large bone that makes up the heel of the foot. Sever’s disease is a common cause of heel pain in physically active children in the early part of puberty, usually between ages 9-14.

Symptoms

Symptoms of Sever’s disease include the following:

• Pain in one or both heels, usually at the back
• Difficulty walking, walking with a limp, or walking on tiptoes
• The heel may appear red, swollen and warm
• Pain when the heel is squeezed on both sides
• Usually seen in physically active children between 9 and 14
• Symptoms improve with rest and worsen with activity

Risk Factors

Sever’s Disease can be caused by the following:

• Repetitive stress resulting from sports that involve running and jumping.
• Standing for extended periods of time causing constant pressure on the heel
• Poor-fitting shoes and improper footwear

Risk factors for developing Sever’s Disease include the following:

• Physically active children at the onset of puberty who are involved in running and jumping activities are at increased risk of developing Sever’s disease.
• Short leg syndrome, a condition where one leg is shorter than the other, can cause pulling of the Achilles tendon leading to Sever’s disease.
• Being overweight creates more pressure on the growth plate.
• Flat arches, high arches, or pronated foot, where the foot rolls inward, can cause tightness of the Achilles tendon thereby increasing pressure on the heel.

Diagnosis

Your physician will diagnose Sever’s disease based on medical history and physical examination. Your doctor performs a physical examination of the heel to assess for swelling, redness, and localized tenderness.Your doctor may perform a squeeze test toassess whether the pain occurs when squeezing the back part of the heel from both sides.

Although Sever’s Disease cannot be seen on an X-ray, your physician may order them to rule out other problems such as a fracture.

Treatment

The goal of treatment is to relieve the pain. Treatment options include:

Rest

Any activities that cause heel pain should be stopped until the pain resolves. Adequate rest relieves pressure on the heel bone reducing swelling and tenderness.

Ice or cold packs

Ice wrapped in a towel should be applied to the injured heel for 20 minutes 3 times a day to reduce swelling.

Compression

An elastic wrap or compression stockings may be used to help reduce the swelling and pain. Elevating the heel above the heart level also helps with the swelling.

Exercises

Calf stretch, heel cord stretch, and hamstring stretch are performed to stretch and strengthen the leg muscles and tendons on the back of the leg. These should be done 2 -3 times a day, holding each stretch for 20 seconds.

Strengthening exercise using a bungee cord or rubber tubing is also performed 2-3 times a day to strengthen the muscles on the front of the shin. The child should sit on the floor keeping the affected leg straight. One end of the bungee cord is tied around a table leg and the other end around the child’s toes. Then the child moves back just far enough to stretch the cord. The foot is slowly bent towards the child’s body, then the foot is pointed towards the table in the opposite direction.

Medications

Over-the-counter NSAIDs may be taken to reduce the pain and swelling. Never give children aspirin due to the risk of a serious illness called Reyes Syndrome.

Orthotic devices

Orthotic devices such as heel pads, heel lifts or heel cups are recommended in children with pronated feet, and flat or high arches. These provide cushion to the heel and reduce the strain on the Achilles tendon. In severe cases, a short leg cast may be applied for 4 to 6 weeks to immobilize the foot so that it can heel.

Prevention

Sever’s disease can be prevented with the following recommendations:

• Wearing good quality, well-fitting shoes with a shock-absorbent sole to reduce pressure on the heel
• Avoid heavy or high heeled shoes
• Avoid excessive running on hard surfaces
• Stretching exercises and ice application should be continued after sports activities to prevent recurrence of Sever’s disease.