Heel pain (Sever’s disease)

What is it?
Sever’s disease, also called calcaneal apophysitis, is a painful bone disorder that results from inflammation (swelling) of the growth plate in the heel.

Sever’s disease is a common cause of heel pain in growing kids, especially those who are physically active. It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids grow most rapidly. This growth spurt can begin any time between the ages of 8 and 13 for girls and 10 and 15 for boys.

What causes it?
During the growth spurt of early puberty, the heel bone (also called the calcaneus) sometimes grows faster than the leg muscles and tendons. This can cause the muscles and tendons to become very tight and overstretched, making the heel less flexible and putting pressure on the growth plate. Over time, repeated stress (force or pressure) on the already tight Achilles tendon damages the growth plate, causing the swelling, tenderness, and pain of Sever’s disease.

Such stress commonly results from physical activities and sports that involve running and jumping, especially those that take place on hard surfaces, such as athletics, basketball, soccer, and gymnastics. Poor-fitting shoes can contribute to the condition by not providing enough support or padding for the feet or by rubbing against the back of the heel.

Although Sever’s disease can occur in any child, these conditions increase its incidence

  • pronated foot type
  • flat or high arch
  • leg length difference
  • overweight or obesity

What can be done about it?
The immediate goal of treatment is pain relief. Because symptoms generally worsen with activity, the main treatment for Sever’s disease is rest/activity modification, which helps to relieve pressure on the heel bone, decreasing swelling and reducing pain. As directed by the podiatrist, a child should cut down on or avoid all activities that cause pain until all symptoms are gone. The child can still do things that do not put pressure on the heel, such as swimming and bike riding.

Recovery and Recurrence

One of the most important things to know about Sever’s disease is that, with proper care and advice from your podiatrist, the condition usually goes away within 2 weeks to 2 months and does not cause any problems later in life. The sooner Sever’s disease is addressed, the quicker recovery is. Most kids can return to physical activity without any trouble once the pain and other symptoms go away.