Sever's disease is a type of heel injury that usually occurs in children who are physically active. Most children experience temporary pain without long-term damage. Sever's disease was first described in 1912 by an American doctor named James Warren Sever. The condition is also called calcaneal apophysitis.
According to the American Academy of Family Physicians, the most common cause of heel pain in children ages 5-11 years old is Sever's disease. It is usually caused by inflammation due to an excessive force or overuse of the growth plate in the heel or the epiphyseal plate. The epiphyseal plate is an area at the end of children's bones that produces new tissues for the growth and shape of children's developing bones.
This condition usually occurs during children's growth spurts, which often begin when girls reach the age of 8-10 and when boys turn 10-12 years old. It is also commonly seen in children at the start of a new sports season since children put extra pressure on their heels while engaging in different sports activities. When children reach 15 years old, the risk of developing Sever's disease significantly decreases. The reason is that bone growth during this time is usually complete and the children's growth plate has also hardened.
Sever’s disease occurs when there is an excessive force on the growth plate of the heel. The heel bone during adolescence grows at a faster rate, which makes it hard for the muscles and tendons to keep up. During this time, there would be an overstretching of the soft tissues, which reduces the flexibility of the heel. There is also an extra pressure put on the growth plate. When the muscles and tendons are excessively strained or stressed, pain and swelling occur. Children who engage in the following physical activities are more prone to developing Sever's disease:
- Prolonged standing
Earlier, it was thought that boys are more commonly affected by the condition; however, as more girls participate in sports nowadays, both sexes have been equally affected. Studies have shown that 11-year-old children have an increased risk of developing the condition.
Other factors that are associated with the condition may include:
- Wearing ill-fitting shoes
- Activities on hard surfaces
- High or flat arches
- Pronation of the foot
- Leg length discrepancies
- Being overweight or obese
Doctors often recommend a combination of treatment when it comes to treating children with heel pain. The main goal of treatment is to relieve pain and tenderness. Reducing pressure on the growth plate and swelling are also other priorities.
The initial treatment for Sever's disease is rest. Children with heel pain must avoid any type of physical activity that can worsen the symptoms. Resting can lead to a pressure reduction on the heel bone as well as reduce pain and inflammation. Children can gradually go back to their normal activities once their injury has healed. Other treatment options for Sever's disease usually include:
- Medication – Children can take over-the-counter medications to ease pain and inflammation. However, parents, guardians, or caregivers should also ask the pharmacist about safe pain relievers for children since there are pain medications that are not suitable for children, such as aspirin, which has been linked to a rare but life-threatening condition called Reye's syndrome.
- Ice Therapy – Aside from resting the child’s foot, ice packs can be used to help reduce the swelling. However, avoid placing the ice pack directly to the child’s skin since it can cause cold-induced burn injuries. Ice packs should be wrapped in a towel or cloth before applying to the heel for 20 minutes three times a day.
- Elevation – Let children lie down with their foot elevated to reduce pain and swelling.
- Compression – Children can also wear compression wraps or stockings to help reduce swelling, pain, and other discomforts.
- Orthopedic Support and Shoe Inserts – To help reduce stress on the child’s heel bone, special orthopedic shoes or insoles may be recommended by the doctor for additional support.
- Exercises – Exercises for the leg and foot can help strengthen and stretch children’s muscles and tendons. Just make sure to consult your child’s doctor before doing any type of exercise.
- Immobilization – Children with a severe case of the disease may need to wear a cast for three months to encourage proper healing of the foot.
Other treatment options include:
- Modification of sports activities.
- Immediately addressing any biomechanical factors that can cause or contribute to the problem.
- Foot function can be improved by the application of sports tape and temporary padding.
- Physical therapy such as gait training can be done to encourage children to improve toe walking or limping and to return to their normal walking pattern.
- A podiatrist may assess children's leg muscle strength and can offer some suggestions on strengthening exercises to help control abnormal movements along with reducing stress on the foot.
Sever’s disease usually goes away after two weeks to two months with proper care. Moreover, the condition does not cause any long-term problems. A quicker recovery can be achieved if the injury is immediately addressed. Most children can return back to their normal physical activities once their symptoms go away and the pain subsides.
Sever's disease can also recur if preventive measures are not taken during children’s growth spurts. Ensure that your child wears good quality and well-fitting shoes. Shoes with padded soles (shock-absorbent) can help minimize heel pressure. Children should avoid wearing shoes that are heavy or have high heels. Doctors may also recommend sandals or clogs that have open backs.
Doctors usually recommend special orthotic devices for children with a pronated foot or other conditions that increase the risk of developing Sever’s disease. They include:
- Arch supports for the heel
- Heel pads to cushion the heel
- Heel lifts to help raise the heel and reduce the strain on the Achilles tendon
For obese or overweight children, doctors usually recommend losing weight to reduce the pressure on the heel.
Within 2-3 months, Sever’s disease gets completely better. However, further treatment may be needed if the condition recurs. It has an excellent long-term outcome. Moreover, no permanent problems have been associated with this condition.