Sever's Disease (Calcaneal Apophysitis)

What is Sever’s Disease?

Sever’s disease, also known as calcaneal apophysitis, occurs in children when the growth plate at the back of the heel becomes inflamed or is injured. The foot is one of the first body parts to grow to full size, usually during puberty. During this time, bones often grow faster than muscles and tendons. As a result, the muscles and tendons become tight and the Achilles tendon attachment to the back of the heel becomes less flexible. During weight-bearing activity, the tight heel tendons may put too much pressure at the back of the heel causing injury or inflammation of the growth plate.

Risk Factors for Sever’s Disease

Your child is most at risk for this condition when he or she is in the early part of the growth spurt in early puberty.  Sever’s disease is most common in physically active boys and girls 8 to 14 years old.  Children who participate in sports involving running or jumping may be at an increased risk. Sever’s disease rarely occurs in older teenagers because the back of the heel has typically finished growing by the age of 15.

Symptoms of Sever’s Disease

In Sever’s disease, pain can be present in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp or have a tendency to tiptoe. The pain may increase when he or she runs or jumps.  Your child’s heel may hurt if you squeeze it side to side. Your doctor may also find that your child’s heel tendons have become tight.

Treatment for Sever’s Disease

Early in the treatment of Sever’s disease your child should decrease or stop any activity that causes heel pain.  Applying ice to the injured heel for 10-15 minutes 3 times a day and particularly after activity is helpful. If your child has a high arch, flat feet or bowed legs, your doctor may recommend orthotics, arch supports or heel cups. Your child should avoid going barefoot. If your child has severe heel pain, medicines such as ibuprofen or acetaminophen may help.

Stretching and Strengthening

Stretching exercises can help. It is important that your child performs stretching exercises for the hamstring, calf muscles, and the tendons on the back of the leg.  Your child also needs to do exercises to strengthen the muscles on the front of the shin.  Both legs should be exercised, even if the pain is only in one heel.  Your child should do these exercises at least twice a day.

Return to Activity

With proper care, your child should feel better within 3 to 6 weeks and can start playing sports again only when the heel pain is gone. Your doctor will let you know when physical activity is safe. No long-term problems have been linked with Sever’s disease since the problem completely resolves once the growth plate closes. If your child’s heel pain does not get better with treatment, gets worse, or if you notice changes in skin color or swelling, your child should follow up for reevaluation.

Prevention of Sever’s Disease

Sever’s disease may be prevented by maintaining good flexibility while your child is growing. Stretching and strengthening exercises can lower your child’s risk for injuries during the growth spurt. Good-quality shoes with firm support and a shock-absorbent sole will help. Your child should avoid excessive running on hard surfaces.

If your child has already recovered from Sever’s disease, stretching and strengthening exercises and appropriate supportive footwear will help keep your child from developing this condition again.

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