What is Sever's Disease?
The most common cause of heel pain in children is due to the disturbance or damage of the growth plate at the rear of the heel bone (calcaneus). This condition is known as Sever’s disease or calcaneal apophysitis. It occurs when an increased tension is placed on the back of the heel from tightness in the calf muscles, causing stress on the cartilaginous growing region within the calcaneus.
The condition is self-limiting and will cease when the two parts of the heel bone fuse together, however this may take up to a couple of years in some cases (around age 13-14). There is no identified long term complications associated with Sever’s disease.
Nevertheless, it is a painful condition that needs treatment to reduce pain levels and maintain activity levels of the child until the heel bone fuses into an adult bone.
Causes of Sever's disease
There is no specific cause of Sever’s disease. However, there are several common factors associated with the condition including:
- Ages 10-14, boys more so than girls.
- Tight calf muscles
- Use of flat, low heeled athletic footwear (eg football boots)
- Puberty/growth spurts
- External factors, e.g. hard surfaces
- Increase in weight bearing physical activity levels
Clinical Presentation
Sever’s disease usually presents as pain in the back or side of the heel, which is generally worse after sports or running/jumping. One or both heels can be affected. It is most common in ages 10-14 as the growth plate at the back of the heel bone is closing.
It may cause the child to limp or walk on tiptoe to avoid placing the heel under increased tension from the Achilles tendon and calf muscle.
Additional Management
Further treatment options include taping the foot to limit movement, and orthotic therapy to correct underlying biomechanical issues.
For severe cases, immobilisation in a walking boot or cast for several weeks may be necessary. Other supportive measures include icing the painful area and, if needed, taking pain medication.
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