What is Sever’s Disease?

• The most common cause of pediatric heel pain is a condition called Sever’s Disease. This condition is also know as calcaneal apophysitis. The calcaneal growth plate (aka calcaneal apophysis) becomes irritated and painful.

Where does Sever’s Disease Hurt?

• The pain is localized to the open growth plate in the heel.
• Children will complain of localized pain to their heel.
• Their symptoms will occur during and after sports.
• To diagnose Sever’s Disease, gently squeeze your child’s heel. This will reproduce their painful symptoms.

How Does Sever’s Disease Occur?

• A tight calf muscle can cause Achilles tendon tension at its insertion point. The insertion just happens to be on the calcaneal growth plate! This tension causes the painful symptoms.
• Sever’s disease is most commonly seen in active children around the ages of 11-14.
• Pain always resolves once the growth plate fuses, which is around the ages of 13-15 years old.
• Surgery is not necessary.
• It is important to get x-rays to make sure there are no fractures of the growth plate. If a fracture is seen on x-ray, then cast immobilization is necessary for 4-6 weeks.

How do you treat Sever’s Disease?

• Ice the heel after sports! Contrast baths are also effective pre-activity and post-activity therapy.
• I encourage calf stretching twice daily. Perform a static 3-5 minute stretch for each calf after activities. Before activities, avoid static stretching, and focus on a dynamic warm up.
• Decrease weight bearing activities until symptoms resolve. This may mean cutting your child’s running mileage or game time in half. Meanwhile, this is a great time to introduce your child to cross training. Their fitness will improve, and hopefully you can help prevent the dreaded feeling of being “sidelined by injury”.
• Orthotics can be an extremely effective treatment modality. A custom orthotic with a deep heel cup is recommended.
• Stick with supportive athletic shoes until symptoms resolve. Flip flops, flats, and barefoot walking will likely increase your child’s symptoms.