Heel Pain in Children (Sever’s)
What is Sever's Disease?
Sever’s Disease or calcaneal apophysitis is the most common cause of heel pain in a growing child and is due to overuse and repetitive micro-trauma of the growth plate within the calcaneus (heel bone). As scary as the name may sound, it is not a disease, but an overuse condition. Sever’s is most common between the ages ten to 14 and is more common in boys than girls.
What are the symptoms?
- Pain or tenderness in the heel (especially squeezing edges of heel)
- Discomfort upon walking first thing in morning
- Limping, difficulty with walking
- More pain associated with running or playing sport – during and after
What causes Sever's Disease?
Although every child goes through the stage of having an open growth plate in their heel, not every child will develop Sever’s Disease.
A growth plate is a layer of cartilage usually found at the end of a bone, allowing the bone to grow in length. It is weaker and more vulnerable to injury than the rest of the bone. When the child has finished growing the growth plate disappears and the bone becomes one complete bone).
Children more likely to develop Sever’s will have:
- Tight calf muscles and achilles tendon
- Over-pronated feet/collapsing arches
- Rapid increase in height
- Play explosive sports such as soccer, hockey, football etc.
- Hard playing surfaces, lots of barefoot running
- Sudden increase in activity (start of sport season)
- Poor footwear (lack of cushioning and support)
What are the treatments?
- Reduce physical activity but don’t completely stop
- Stretch calf muscles and Achilles tendon
- Ice & massage; natural anti-inflammatory gels such as FisioCrem
- Avoid going barefoot, correct supporting footwear
- Arch strapping to reduce load on Achilles tendon
If the symptoms are not improving then the underlying biomechanics need to be addressed. This may include:
- Cushioned heel raises to reduce the strain on the growth plate
- Foot supports (orthotics) to control over-pronation
Sever’s disease is self-recovering - just like Osgood Schlatter Disease – meaning it will go away completely when the two parts of bony growth join together. There are no known long term complications associated with Sever’s disease.
Unfortunately however, Sever’s disease can be very painful and limit the child’s sporting activity while they are waiting for it to go away, in some instances making them feel like ‘throwing in the towel’. Symptoms commonly last for one to six months (varies greatly) but often recur on many occasions until the growth plate fuses – particularly when they go through episodes of rapid height growth.
For this reason, ‘telling your child to rest, it will go away on its own eventually’ is poor advice. Ask yourself, why would you let your child go through pain for weeks, months and in some instances years, when the pain can be easily managed or resolved. Between the ages of seven to 14, it is most important for children to be participating in sport to develop motor co-ordination, balance, fitness and social skills.