Sever’s disease, or calcaneal apophysitis as it’s medically known, sounds worrying but is surprisingly common.
It’s a condition that affects children, usually during a growth spurt in adolescence, and even though it’s temporary with no lasting effects, it can be painful and debilitating.
Sever’s disease symptoms
Typically, Sever’s sufferers will complain of pain in one or both heels, often at the back and sometimes the sides of the heel. The pain gets worse during and after activity, to the point where they may have some difficulty walking and have to hobble off the sports field. It can be sore to touch, or if the heel is squeezed, but usually swelling and redness doesn’t occur.
The good news is, is that getting onto it quickly with the right treatment, Sever’s will most likely be self-limiting and last anywhere from two – 12 weeks.
What causes Sever’s disease?
In children, the calcaneus (heel) bone is in two parts that are joined by an area of cartilage known as the growth plate (or epiphyseal plate). This, along with other growth plates in bones in the skeleton, allows for kids’ bones to grow as they get older and bigger.
By about the age of 15, the growth plate is fused and the calcaneus becomes one solid bone, but while the cartilage is in place it is weaker than normal bone and more prone to injury.
Sever’s occurs when there is rapid growth of the leg bones and calcaneus. The calf muscles and Achilles tendon become tight and struggle to keep up with the demand on them to lengthen accordingly. As the Achilles tendon strains repeatedly on the heel, the plantar fascia pulls in the opposite direction and pressure is placed on the growth plate. Inflammation and pain are the result.
The same can occur in Osgood Schlatter disease, at the knee.
Who is most at risk of getting Sever’s?
It can occur in any child, but is more typical in very active children between the ages of 8-15.
Sports that include repetitive running and jumping are more likely to exacerbate symptoms, especially if the playing surface is hard.
As well, some biomechanical factors such as over pronation, very flat or high arches and uneven leg length can predispose people to Sever’s.
How is Sever’s disease diagnosed?
Mainly through the symptoms described by the sufferer, and examination of the foot/ankle. An x-ray will show if the growth plate is still open, and will rule out fractures, but it can’t diagnose Sever’s.
How is Sever’s disease treated?
The first goal of treatment is pain relief such as ice, elevation, compression and, if needed, medication such as paracetamol and ibruprofen.
Rest, or at least significant reduction in the aggravating sports/activities, is important to allow the inflammation to settle and reduce reoccurrence. Other activities like swimming or biking might still be ok, providing they don’t cause pain.
High quality, well-fitted shoes are recommended to help support the foot properly and reduce loading on the Achilles. Look for shoes with a firm heel counter and good shock absorbency.
Avoid shoes with heels or running barefoot, which can increase Achilles tightness even more, or alternatively overload it.
It is worth a visit to a podiatrist if there are altered foot biomechanics and orthotics may need to be prescribed.
Reassure your child that despite the condition being frustrating and painful, it is one that will clear up with the right management.