Sever's Disease (Calcaneal Apophysitis) - Heel Pain in Children

Is your child complaining of heel pain? Is he/she limping or walking on their toes? This could be Sever's Disease, also called calcaneal apophysitis, an inflammation of the heel growth plate. To prevent Sever's Disease, fit your child with kid's shoes with good cushioning in the footbed, shock absorption in the heel, and support in the outsole. Make sure children wear supportive shoes, especially when they're running and jumping, to reduce the impact on the heel and strain on the developing bone and muscle structure of a kids' feet. Children's arch supports and heel cups comfortably support the foot and encourage healthy alignment while your child runs or walks. If your child is already experiencing heel pain, Dr. Hurless recommends reducing the child's strenuous physical activities and fitting their shoes with heel cups. Once the child recovers from heel pain the parent should then fit their shoes with pediatric arch support inserts to prevent recurrences of heel pain. Sever's Disease is self-recovering and will subside when the foot is fully developed. Without treatment heel pain associated with Sever's Disease may last several years.

What Is Causing My Child's Heel Pain?

There are a number of possible causes for a child's heel pain. Because diagnosis can be challenging, a foot and ankle surgeon is best qualified to determine the underlying cause of the pain and develop an effective treatment plan. Sever's disease, also known as calcaneal apophysitis, is by far the most common cause of heel pain in children. Other causes of heel pain include tendo-achilles bursitis, other overuse injuries, and fractures.

What Is Sever's Disease or Calcaneal Apophysitis?

Sever's disease is an injury to a child's still developing foot structure, specifically an inflammation in the heel's growth plate due to muscle strain and repetitive stress. It is common in young athletes and children who have problems with pronation. Sever's Disease usually occurs in children age 8 - 14 years of age when the child's bones are still in the growth stage and the growth plates have not become ossified.

What Causes Sever's Disease or Calcaneal Apophysitis?

The cause of Sever's Disease is not entirely clear but it is most likely due to repeated minor trauma that occurs during high-impact activities that involve running and jumping such as soccer, basketball, and gymnastics. It may also occur when an active child regularly wears shoes with poor heel padding, shock absorbency, or poor arch support. Some additional contributing factors are excessive pronation, an overly tight calf muscle, and other flaws in the biomechanics of a child's walking stride. Children who are overweight are also at greater risk of developing Sever's Disease.

What Are the Symptoms of Sever's Disease?

Sever's disease causes pain and tenderness in the back and bottom of the heel when walking or standing, and the heel is painful when touched. It can occur in one or both feet.

Podiatrist Recommendations:

Reduce activity, avoid going barefoot, and cushion the child's heel with shock absorbency. It is very important that your child wear shoes with padded heel surfaces and shoes with good arch supports even when not participating in sports. A heel cup or soft pediatric shoe insert is very important to reduce the pull from the calf muscles on the growth plate and to increase shock absorption and reduce irritation. The use of an ice pack after activity for 20 minutes is often useful. Your health care provider may also prescribe anti-inflammatory drugs or custom orthotics.

Preventing a Sever's Disease Relapse:

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.