Understanding Sever's Disease: Causes, Symptoms, and Treatments for Heel Pain in Kids

Heel pain in active kids is a common complaint. Between the ages of 7- 9 in girls and 10-12 in boys, the growth plate (or apophysis) at the back of the heel (the calcaneus) is a weak spot that can become inflamed with excessive loads from the calf and Achilles tendon complex.

This condition is known as Calcaneal Apophysitis or Sever’s Disease. This condition will resolve when the growth plates fuse but can be very debilitating until then.

It typically occurs following a sudden increase in running and jumping activity – at Peninsula Ankle Rehab we often see this at the start of a season or after having played multiple games at a tournament.

Sever’s disease is the most common cause of heel pain in this age group. It can be 1 sided (unilateral) or on both heels at the same time (bilateral) and the pain will intensify during and after activity. It is a mechanical overload injury where increased tension and shear stresses are exerted over the unossified or partly ossified apophysis from the Achilles tendon. This creates a traction injury leading to microtrauma and inflammation.

Here in Victoria on the Mornington Peninsula, where basketball and Australian Rules are popular sports, these injuries are common. The start of the football season is often a high-risk period where pre-season running drills (in flat football boots) and basketball can take up the most evenings of the week.

Limited dorsiflexion, poor footwear and altered foot alignments are also common risk factors

Investigations are rarely needed but in severe cases an MRI will confirm the diagnosis.

First line management is around activity modification guided by pain levels. This will often involve a breakdown of the patient’s weekly sport commitments and an agreed plan of where a reduction in running and jumping activities can be made. A complete ban on all activities is to be avoided where possible and introducing non-impact activities such as cycling or swimming is often recommended.

Once we controlled the running and jumping activity to a tolerable level, we then address any foot alignment issues and we unload the Achilles tendon with suitable footwear, heel wedging, orthotics (if appropriate) and taping.

During the acute inflammatory stages of this injury I generally avoid stretches and strengthening exercise as they often further inflame the irritated structures. However, once the pain has settled and activity is pain free, I will recommend a regular stretch program to continue with.

Although Sever’s Disease will settle as the growth plates fuse it is a very frustrating condition as it often results in limiting activity in kids that love their sport and exercise. Therefore, I would certainly recommend seeing either your physiotherapist or podiatrist sooner rather than later to form the best management plan