Understanding Severs Disease & Treatment Options

Understanding Sever’s Disease: A Podiatrist’s Perspective

Sever’s disease, or calcaneal apophysitis, is a common cause of heel pain in growing children, particularly those who are physically active. This condition occurs when the growth plate in the heel (calcaneus) becomes inflamed due to repetitive stress, typically affecting kids between the ages of 8 and 14. It’s one of the most frequent causes of heel pain in young athletes and can impact their daily activities and sports performance.

As a podiatrist, I see many young patients with Sever’s disease, and while it can be painful and limiting, the good news is that it’s treatable and generally resolves once the child’s growth plate closes. Early diagnosis, rest, and specific treatments can alleviate symptoms and prevent worsening of the condition.

Causes of Sever’s Disease

Sever’s disease is primarily due to overuse and stress on the heel’s growth plate, which is a soft area of cartilage at the back of the heel bone. In children and adolescents, these growth plates are still developing and are more vulnerable to irritation and injury than mature bone tissue. The two main factors contributing to Sever’s disease are:

Repetitive Stress from Physical Activity: Sports and activities that involve running, jumping, or sudden changes in movement—such as soccer, basketball, gymnastics, and track—can put considerable stress on the heel. Each time the foot strikes the ground, it pulls on the growth plate, causing micro-trauma and inflammation.

Growth Spurts: During a growth spurt, the bones, muscles, and tendons don’t always grow at the same rate. Often, the bones grow faster than the surrounding muscles and tendons, leading to increased tension and tightness in the Achilles tendon. This added tension pulls on the heel’s growth plate, contributing to inflammation and pain.

Symptoms of Sever’s Disease

Sever’s disease typically affects one or both heels and can cause symptoms such as:

Heel Pain: Pain is usually localised at the back or bottom of the heel. It often worsens during or after physical activity and may improve with rest. 

Swelling and Tenderness: The heel may appear swollen or tender to the touch, especially around the back and sides.Limping or Walking on Toes: Because heel pain worsens with pressure, some children may limp or walk on their toes to avoid discomfort.

Stiffness: Tightness in the Achilles tendon and calf muscles is common and may limit ankle flexibility.

Diagnosing Sever’s Disease

A diagnosis of Sever’s disease is typically based on a clinical examination and the child’s history of activity, pain, and growth patterns. During the examination, I’ll look for tenderness in the heel and assess any tightness in the Achilles tendon or calf muscles. While X-rays aren’t typically necessary, they may be used to rule out other causes of heel pain, such as fractures or infections.

One common test for Sever’s disease is the Squeeze Test, where I gently squeeze both sides of the heel. If this maneuver reproduces the child’s pain, it often indicates inflammation in the heel’s growth plate.

Treatment Options for Sever’s Disease

The primary goals of treating Sever’s disease are to reduce inflammation, relieve pain, and allow the child to return to normal activities once symptoms improve. Here are the main treatment approaches:

Rest and Activity ModificationRest is crucial to recovery, and I typically recommend that the child take a break from high-impact sports and activities until pain subsides. This rest period allows the growth plate to heal. Once symptoms improve, they can gradually return to activity.

Ice Therapy Applying ice to the heel for 10-15 minutes several times a day, especially after physical activity, can reduce inflammation and alleviate pain.

Heel Pads or Orthotics Adding cushioned heel pads to the child’s shoes can reduce pressure on the heel and absorb shock. In some cases, custom orthotics may be beneficial, especially if the child has flat feet or other foot alignment issues that contribute to heel strain.

Stretching and Strengthening Exercises Tight Achilles tendons and calf muscles can worsen symptoms of Sever’s disease, so I usually recommend a program of gentle stretching exercises for the calf and Achilles tendon. Strengthening exercises for the foot muscles may also help support the heel and reduce stress on the growth plate.

Temporary Immobilization In severe cases, where symptoms do not improve with conservative treatment, a short period of immobilization in a cast or walking boot may be necessary to allow the heel to heal fully.

Preventing Sever’s Disease

While Sever’s disease is often difficult to prevent entirely, especially in active children, the following measures can help reduce the risk and severity of symptoms:

Proper Footwear: Shoes with good arch support and cushioning are essential for children engaged in sports. Avoiding shoes with minimal support or high heels is also important.

Stretching: Encouraging regular stretching exercises for the calf muscles and Achilles tendon can improve flexibility and reduce the pull on the heel’s growth plate.

Limit High-Impact Activities: Alternating high-impact sports with low-impact activities, such as swimming or cycling, gives the feet a chance to rest and recover.

Awareness of Growth Spurts: During growth spurts, parents and coaches should be aware of increased vulnerability to injuries like Sever’s disease and adjust activities accordingly.

Frequently Asked Questions (FAQs)

1. Can Sever’s disease cause long-term problems?

No, Sever’s disease does not cause long-term problems or permanent damage to the heel. It typically resolves once the child’s growth plate matures. However, proper management and treatment are essential to avoid prolonged pain.

2. How long does it take to recover from Sever’s disease?

Recovery time varies depending on the severity of symptoms and adherence to treatment, but most children recover within a few weeks to a few months with rest and appropriate care.

3. Should my child completely stop playing sports if they have Sever’s disease?

In mild cases, activity modification (reducing intensity or duration) may be sufficient, but in more severe cases, a complete break from sports is recommended until symptoms improve. Resuming sports too early can lead to a flare-up of symptoms.

4. Are custom orthotics necessary?

Not always. For some children, over-the-counter heel pads or supportive footwear may be enough. Custom orthotics are considered if the child has specific foot alignment issues, such as flat feet, that contribute to heel stress.

Sever’s disease can be a painful and frustrating condition for young athletes, but with proper treatment and rest, most children make a full recovery and return to their activities. As a podiatrist, I emphasize early intervention and a tailored approach to manage symptoms and prevent recurrence, helping kids stay active while protecting their growing feet.