Most of the time when parents hear the word disease, they are instantly worried. Sever’s disease has a scary name for a reasonably standard heel injury that is most commonly seen in children. Children who play sports and are active are most at risk for developing Sever’s disease.

Also called calcaneal apophysitis, Sever’s disease is one of the most common reasons for heel pain in children between eight and fifteen years old. The pain is located at the back of the heel. Luckily, if it is adequately managed, kids will usually grow out of it.  

While calcaneal apophysitis is painful, it is a temporary pain that does not bear any long-term effects. If you have a child or teenager who is complaining about pain in their heel, Sever’s disease may be the culprit. Here is more information about Sever’s disease and its causes, symptoms, treatment, and prevention.

Understanding Sever’s Disease

While Sever’s disease is a painful bone disorder, it is one that is caused by overuse and healed with rest and time. When a child athlete has Sever’s disease, he or she will experience swelling around the growth plate located on the heel. Growth plates, also known as epiphyseal plates, are located at the end of bones and consist of a flimsy group of cartilage cells that transform into bone cells over time.

Growth plate injuries are of concern to many parents because they are often associated with surgery. Sever’s disease is not like bone breaks or fractures that cross growth plates. Instead, it does not require surgery, and most kids grow out of as soon as their growth plates are fully developed into bone.

There is around a two-year period, during the early stages of puberty, when kids grow quickly. Initial puberty growth spurts happen when kids are between eight and fifteen years old, and it is during that time when Sever’s disease is most common for children who are athletes.

It is extremely rare for any teenager over fifteen years old to get Sever’s because the growth plate on the back of the heel is done growing by the time a young adult reaches fifteen years old. Once the growth plate hardens, it fuses the bones together and makes a solid bone.  

There are several causes that can affect a child’s likelihood of experiencing Sever’s disease.

Causes of Sever’s Disease

The heel bone, also known as the calcaneus, will sometimes grow very quickly, faster than the leg muscles and other tendons. When the heel bone grows rapidly, it causes the other tendons and muscles in the leg to become overstretched or tight which reduces flexibility in the heel. That process puts extra pressure on the growth plate.

When a child is active, especially in sports, he or she is putting normal pressure and force into the Achilles tendon, also called the heel cord). When the heel plate grows too quickly and makes the Achilles tendon tight, and then the athlete continues to put pressure on it, it causes damage to the growth plate. Once damage starts to happen, the child begins to experience tenderness, swelling, and pain.

Sports that require movements that put stress on the heel are jumping, running, track, basketball, gymnastics, and soccer.

Although less frequent, Sever’s disease can also occur when kids stand too long with pressure on the heel, or who wear shoes that don’t fit properly. Sever’s disease can happen to any kid, but there are a few conditions that increase the potential. These include:

  • Short leg syndrome. When one leg is shorter than the other, the foot on the short leg has to bend down to compensate for the length difference, and that puts pressure on the Achilles tendon.  
  • Pronated foot. Feet that roll inward at the ankle when walking cause twisting of the Achilles tendon, tightness, and therefore, pull on the heel growth plate.
  • Overweight or obesity. The extra weight that children carry adds additional pressure on joints, growth plates, tendons, and muscles.
  • High arches and flat arches. The arch affects the placement of the heel inside the foot, which causes the Achilles tendon to tighten and shorten when the growth plate needs it to expand.

There are several common symptoms that kids experience if they have Sever’s syndrome.

The Symptoms of Sever’s Disease

While the most classic symptom of Sever’s disease is tenderness and pain in the heel, typically at the back, the pain can also extend beyond the heel. Sometimes kids will experience pain on the bottom of the foot or the sides of heel, stretching all the way to the arch.  

Some of the other more common symptoms include:

  • Swelling in the heel.
  • Redness around the heel.
  • Difficulty walking, especially long distances.
  • Stiffness in the foot when first waking up.
  • Discomfort when first waking up, and if the heel is squeezed.
  • Unusual gait: walking on tiptoes, or with a limp, to avoid the pain of walking.
  • Worsening symptoms when exerting themselves.

Among the different common symptoms, another sign of Sever’s disease is that it typically gets better with rest.  

Treatment of Sever’s Disease

There aren’t any definitive tests, like x-rays, which diagnose Sever’s disease. Doctors can usually tell if a child is experiencing the condition because of their reaction to the doctor putting pressure on both sides of the heel or asking the child to walk in different positions to see if it reduces the pain. Once diagnosed, there are various treatment options that may be used.  

It is common for doctors to recommend elevating and icing the heel in 20-minute increments, multiple times a day. Doing both will help reduce inflammation and pain.

Relieving Pressure

The first Sever’s disease treatment goal is pain relief. Most kids experience the pain when they are active so doctors will usually recommend plenty of rest for the heels, to help with swelling, relieving pressure, and reducing pain. It is often hard for athletic children to sit out of their chosen sports activities; however, avoiding the events that caused the disease is necessary until the symptoms go away.  

After the symptoms go away, kids should be aware of what caused the disease and try to avoid it as much as possible. Running on hard surfaces, especially while barefoot, increase impact and can cause the symptoms to appear easily.

Sometimes doctors will okay non-impact activity like riding a bike or swimming.

Exercising and Strengthening

Exercises that will strengthen and stretch the leg muscles and tendons will help the healing process. Stretching the muscles and tendons around the heel and back of the foot will help reduce the tightness and increase flexibility.

OTC Pain Reliever

Sometimes doctors will prescribe over the counter medications to help with swelling and pain. The most commonly recommended OTC pain relievers are Tylenol and Ibuprofen. Doctors will not usually recommend stronger medication because pain can be managed by resting the heel.

Wraps and Casts

Elastic wraps and compression socks can sometimes help support the foot to relieve pain and reduce swelling. If a child is going to continue trying to play sports, wrapping and taping can help with pain and support to help the heel not get any worse.

If the Sever’s disease case is very severe, the doctor may require a cast for two to twelve weeks. If the case is severe enough, a cast will help immobilize the heel, Achilles tendon, and foot to give it time to heal correctly.  

Prevent Sever’s Disease

For kids who are active, and within the eight to fifteen-year range, taking a few extra precautions is a great way to reduce the risk of them getting the disease. Here are a few of the ways that help:

  • Proper stretching. Stretching is easily one of the essential parts of the activity. Many people don’t realize how important stretching is for avoiding injury. Properly stretching before and after working out can help significantly reduce injury risks.
  • Wearing good footwear. Shoes with a shock absorbing heel and heel support are also helpful for avoiding Sever’s disease. Wearing shoes that offer support and absorption help take the pressure off the heel.
  • Orthotics if needed. If your child has a biomechanical issue, like a shorter leg or pronated foot, orthotics can help fix the problem or at least help reduce the strain on the heels and feet.

Final Thoughts

While it is easy to worry when you hear the word disease, Sever’s disease is not severe or life-threatening. It is essential to understand that Sever’s disease is easily treatable and even preventable. With proper care, children can heal between two weeks and two months, and it is not tied to any problems later in life.

Once addressed, the recovery process is straightforward. As soon as symptoms are gone, kids can work up to their previous activity levels.

Preventative measures like supportive shoes, proper stretching and muscle building, and addressing it early can help ensure your child doesn’t have to deal with the discomfort of Sever’s disease.

Children who are athletic and active are most at risk, but no child is immune to the possibility of getting the disease. However, Sever’s is easily treatable, and if your child has it, he or she will be back to their activities in a short time.  

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