Sever’s disease is a common cause of heel pain in active children. Sever’s disease, also called calcaneal apophysitis, occurs when the growth plate of the heel is injured by excessive forces during early adolescence.
Overuse and stress on the heel bone through participation in sports is a major cause of calcaneal apophysitis. The heel?s growth plate is sensitive to repeated running and pounding on hard surfaces, resulting in muscle strain and inflamed tissue. For this reason, children and adolescents involved in soccer, track, or basketball are especially vulnerable. Other potential causes of calcaneal apophysitis include obesity, a tight Achilles tendon, and biomechanical problems such as flatfoot or a high-arched foot.
As a parent, you may notice your child limping while walking or running awkwardly. If you ask them to rise onto their tip toes, their heel pain usually increases. Heel pain can be felt in one or both heels in Sever’s disease.
Low-grade inflammation of the calcaneal apophysis cannot be seen on x-ray. Therefore, although x-rays are often done to rule out bony injuries in children with Sever’s disease these x-rays are usually normal. Advanced Sever’s disease can be seen on x-ray but usually the problem is treated before it reaches this point. Other diagnostic tests, such as bone scans or MRI’s, are not usually required in typical cases of Sever’s disease. These, or other tests, may be required to rule out other conditions, such as stress fractures of the calcaneus or other bony abnormalities that can mimic Severs disease.
Non Surgical Treatment
If the problem is bad enough, it is important to totally rest the symptomatic foot. Take a break from sport activity until the pain has significant improvement. Severe cases will need to be treated with a cast boot. Anti-inflammatory treatments include Icing, Over-the-counter anti-inflammatory medicine as recommended by your pediatrician or podiatrist. Shock absorption and support. Don’t go barefoot at home, wear some type of good sandal or shoe. A significant and/or chronic case should be treated with prescription orthotics. This addresses mechanical problems that cause this problem, Using an over-the-counter heel cushion inside of the shoe, Athletic foot taping, Stretching. Runners stretch to stretch out the calf muscle. A night splint will also help. Severe or chronic cases respond best to prescription orthotics with specific modifications for this problem. May require a night splint. Daytime braces that may also help.
After the painful symptoms of Sever’s disease have gone away, it is important to continue stretching the heel, particularly before a vigorous exercise, and wearing good supportive shoes fitted with children’s arch supports. This will prevent heel pain recurrence until the child’s heel is fully developed and less prone to injury.