Sever’s Disease

What Is Sever’s Disease?

Sever’s disease, also known as calcaneal apophysitis, is the most common cause of heel pain in children—especially between the ages of about 8 and 14. The name is misleading—Sever’s disease is not actually a disease, but an overuse injury. It is caused by inflammation in the growth (epiphyseal) plate of the heel bone, an area of softer bone tissue that is exposed during childhood and adolescence.

Heel pain can keep your child from playing or remaining active, and should be addressed by a foot specialist to ensure a quick and complete recovery.Kids lying down on a field of grass with feet towards the camera

What Are the Symptoms of Sever’s Disease?

The most common symptoms include pain and tenderness at the back of the heel. Pain gets worse during physical activity, and also when the heel is squeezed from both sides.

You might notice some behavioral changes in your child due to the pain they are experiencing. Limping, walking on toes, and difficulty with (or sudden disinterest in) participating in active play or sports could indicate the influence of Sever’s disease.

What Causes Sever’s Disease?

During childhood, the bones are still growing and reaching maturity. At this stage, the ends of many bones—including the heel bone—are “capped” by growth plates made from softer cartilage. By around age 14 or so, the growth plate stops producing new bone and is covered by harder tissue. Until then, however, it is a weak point vulnerable to injury.

Sever’s disease is usually linked to overuse of the heel bone during adolescence. Repetitive running, jumping, and hard impacts from sports (particularly those played on hard or uneven surfaces) can strain and inflame both the growth plate and the muscles and tendons that attach to it, causing pain.

The condition is also associated with tight Achilles tendons or calf muscles, which can “tug” on the sensitive heel bone. It could simply be that, during a growth spurt, the Achilles isn’t able to “keep up” with growth in the heel bone for a time. Often, biomechanical issues like flat feet or high arches can increase the strain on the heel and surrounding tissues.

How Is Sever’s Disease Treated?

If your child is experiencing heel pain, you should always bring them in to see one of our pediatric foot care experts at Northwest Extremity Specialists. Although the condition can sometimes be treated at home, improper treatment can lead to chronic pain and complications. There are also other conditions that can mimic Sever's Disease, like bone cysts, muscle, or ligament injuries. We will conduct a thorough evaluation to ensure that Sever’s is the correct diagnosis, and rule out any more serious conditions.

Common care options include:

  • Rest and ice. Your child will have to avoid painful, high-impact activities for a short time while the injury heals. Using ice packs for around 10 minutes at a time and elevating the heel can also help with pain and swelling.
  • Medication. If safe for your child, over-the-counter anti-inflammatories may be recommended to help with pain temporarily.
  • Shoes. Poor footwear can contribute to Sever’s disease. Make sure your child has well-fitting shoes that were originally purchased for them (i.e., not hand-me-downs) that are appropriate for the sport or activity they play.
  • Support. Orthotics may be prescribed on either a temporary or longer-term basis to ensure your child’s heels and arches get the proper support they need.
  • Physical therapy. We will recommend stretches and other exercises to help heal the inflamed tissue and stretch out the Achilles tendon and calf muscles to reduce strain.
  • Immobilization. In more serious cases, your child may require a short cast or boot to keep the heel immobile as it heals.
Sever’s disease almost always resolves in time using conservative care options such as these. The sooner you bring your son or daughter in for an appointment, the sooner treatment can begin—and the earlier they can return to their activities. To begin, please contact the nearest office of the Northwest Extremity Specialists, or fill out our appointment request form.