Sever?s disease is particularly prevalent among active children between ages 8 and 15. Young boys and girls who play soccer and other sports in which footwear is inappropriate-i.e. too narrow in the
toe box, too rigid, etc. are most commonly affected. Sever?s disease usually appears during the adolescent growth spurt-the 2-year period in early puberty where children grow the quickest. The
adolescent growth spurt occurs between the ages of 8 and 13 in girls and 10 and 15 in boys. Teenagers over 15 years old rarely experience this heel problem, as heel bone growth is usually complete by
this age. Sever?s disease usually self-resolves within 6 months of onset, though it can last longer.
Contraction of the calf muscles along with the rapid growth of the leg bone (tibia), decreases ankle motion and increases strain on the heel area. This puts strain on the Achilles tendon. Injury
results from repetitive pulling through the heel bone by the Achilles and the traction forces from the plantar fascia.
If your child has any of the following symptoms, call your pediatrician for an evaluation. Heel pain that begins after starting a new sports season or a new sport. Walking with a limp or on tiptoes.
Pain that increases with running or jumping. Heel tendon that feels tight. Pain when you squeeze the child's heel near the back. Pain in one or both heels.
This condition is self limiting, it will go away when the two parts of bony growth join together, this is natural. Unfortunately, Sever's disease can be very painful and limit sport activity of the
child while waiting for it to go away, so treatment is often advised to help relieve it. In a few cases of Sever's disease, the treatment is not successful and these children will be restricted in
their activity levels until the two growth areas join, usually around the age of 16 years. There are no known long term complications associated with Sever's disease.
Non Surgical Treatment
In mild cases, elevating the heel through heel lifts in the shoes and decreasing activity level may be enough to control the pain. In more severe cases, orthotic therapy to help control the motion of
the heel, as well as icing, elevating, and aspirin therapy may be required to alleviate the symptoms. In those children who do not respond to either therapy mentioned above, it is sometimes necessary
to place the child in a below-knee cast for a period of 4-6 weeks. It is important for both the child and parents to understand that the pain and swelling associated with this disorder should resolve
once the growth plate has fused to the primary bone in the heel.
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel.
Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and
inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a
cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence
of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle