Sever's Disease in Children
Symptoms, Causes and Treatment of Sever's Disease and Related Heel Pain
Sever’s disease, also known as calcaneal apophysitis, is a painful inflammation in the heel that results from a dramatic growth spurt. The inflammation comes about due to an abrupt growth when the heel bone grows at a faster rate than surrounding muscles and tendons which become overstretched and tight.
Girls may see their spurts between 6 – 13 years old while boys will experience them around 10 – 16 years of age (depending on individual children’s development rates).
For more detailed advice on how to identify and treat Sever’s disease at home, read Dr. Jarman’s At-Home Guide. »
"As a pediatric podiatrist with over a decade of experience, I have treated thousands of young athletes for a common cause of heel pain known as Sever's Disease. Of all the heel pain issues we see in children at our clinic, particularly ones that play sports, Sever’s accounts for over 85% of these cases.
It's important to note, these are Chronic Severs' disease cases. When we talk about Severs' disease treatment, we are referring to chronic since Acute Severs will generally resolve on its own and does not require treatment.
The underlying cause involves inflammation from repetitive stress to the heel. It most often occurs during the child’s growth spurt, a phase when bones, muscles, and tendons are developing and changing rapidly. For girls this is generally between the ages of six to thirteen, and boys between the ages of ten to sixteen. This condition is much more prevalent in children that play what I refer to as 'ground and pound' sports like soccer, gymnatics, and other similar activities."
How to Identify Sever's Disease
The Squeeze Test
(*For an official diagnosis, we recommend being evaluated by a pediatric podiatrist or other children’s foot specialists.)
The Diagnosis
"This diagnosis of Sever's is identified easily at the office by simply grasping your child's heel and squeezing firmly on the sides. This will place pressure on the growth plate and in turn immediately result in discomfort for the child."
(An MRI and/or xrays are also part of our evaluation to confirm 100% the condition is Sever’s.)
How To Identify And Treat Sever's At Home
Dr. Jarman’s at-home guide for Sever’s disease provides parents with a comprehensive understanding of the condition, including how to identify common symptoms such as heel pain, limping, and stiffness in children. The guide outlines simple tests that can be done at home, such as the Squeeze Test, and discusses treatment options like rest, stretching, and custom orthotics. It also emphasizes how products like the Mikki Device™ can aid in managing symptoms.
Read Dr. Jarman’s At-Home Guide To Identify And Treat Sever’s Disease »
Sever's Disease - What Every Parent Should Know
In the following videos, Dr. Jarman discusses the diagnosis and treatment of Sever’s disease in children, and how to differentiate between acute and chronic.
Video #1 - The Diagnosis
"The key is an accurate diagnosis and being proactive with treatment to prevent unnecessary pain and disruption of activities. With the right management, young athletes can continue participating in the sports they love safely and pain free. My goal is keeping kids active, healthy, and thriving doing what they enjoy most.”
Video #2 - The Treatment
"For chronic cases, I prescribe Mikki Device custom orthotics fabricated specifically from a mold of the child’s foot. In addition, I dispense a pediatric night brace to my patients that gently stretches the calf and heel tendons during the child’s sleep cycle. At our clinic we have an excellent success rate in treating Sever’s Disease.”
Treating Sever's Disease
The first step to a successful outocome is to determine whether or not the child’s Sever’s is acute or chronic. Once that determination is made, the doctor will either recommend conservative treatment options like elevating the foot and rest, if it’s acute, or prescribing a custom shoe insert orthotic if its chronic.
The primary concern of treating this disease is to relieve the pain.The doctor will usually direct the child to cut back on all activities and sports for either diagnosis until the swelling goes down and the pain is gone. Running barefoot or upon hard surfaces are usually the worst offenders, since they impact the feet and can worsen inflammation and pain. If a child wants to remain active, he or she could try biking or swimming since these do not put pressure on the heel. However, you should go over it with the doctor first.
Your child’s feet are their foundation for life.
Looking for a pediatric podiatrist that specializes in heel pain & Sever’s disease treatment?
Dr. Jarman is a board-certified pediatric podiatrist who has been treating children with foot conditions since 2014. He knows the significance of early diagnosis and treatment of foot issues and is dedicated to your child’s health. Make an appointment with Dr. Jarman now and let him help you keep your child’s feet healthy!
The Difference Between Acute & Chronic (and why it matters)
Depending on which type of Sever’s your child has, chronic or acute, will determine which treatment options will have the best results.
"It’s important to note that there are two classifications of Sever's Disease: acute and chronic. Acute cases may resolve with rest and conservative care. A pediatric night brace can be beneficial though for acute Sever’s, and I will sometimes recommend that. Chronic on the other hand will require a more proactive approach."
Acute Sever's
Acute Sever’s is the milder of the two, and will either resolve on its own, or respond very well to conservative treatments like:
- Elevating the leg and applying ice (not directly on the skin) for 15 to 20 minutes 3 times a day.
- Over-the-counter medications like Acetaminophen (Tylenol) or Ibuprofen (Advil and Motrin), not aspirin.
- Rest and ceasing “ground and pound” activities like running, soccer, and gymnastics for two to four weeks.
Almost every young athlete will experience some heel pain from acute Sever’s, but you generally do not need to seek medical care for acute cases. If the child’s heel pain doesn’t resolve on its own and is constant, it is most likely chronic.
Chronic Sever's
Chronic Sever’s is more serious, and as the name implies, is an ongoing condition that affects the child every day even when they are not active. Chronic doesn’t respond to conservative treatments, and a custom orthotic fabricated from the child’s foot specifically is considered the best treatment option.
A custom orthotic:
- Is cast specifically from your child’s foot for a precise fit and maximum effectiveness.
- Is a heel cup that evenly distributes the weight taking the pressure off the heel plate allowing it to heal.
- Is generally prescribed with a nighttime splint to keep the tendons and muscles from tightening back up in the night.
- Learn More About Treating Chronic Sever’s Disease with the Mikki Device
Sever's Disease Custom Orthotic Available Without A Doctor Visit or Prescription
The Mikki Device™
The Mikki Device™ is a custom orthotic shoe insert designed by a pediatric podiatrist to specifically treat Sever’s disease in children. Even when other Sever’s treatment options have failed, the Mikki Device™ has proven effective in over 97% of the children who use it.
Sever's Disease Testimonials & Success Stories
Sever’s is treatable, both acute and chronic conditions. Watch real life stories of Sever’s disease treatment experiences shared by the children and their parents.
Meet Gracie
Meet Jackson
Meet Ryan
Meet Nicholas
Causes of Sever’s Disease
The following conditions may increase your child’s chances of contracting Sever’s disease.
- A child’s growth spurt between the ages of 8 to 15.
- Ground and pound sports like soccer, running, dance, or gymnastics
- A pronated foot, or a foot that rolls at the ankle when walking. This may cause a twisting and tightness of the Achilles tendon, which increases the pull on the heel’s growth plate.
- High or flat arches, which can affect the heel’s angle within the foot.
- A tight achilles tendon.
- Being overweight or suffering from obesity, which may put additional pressure on the growth plate.
- Short leg syndrome. This is when one leg is shorter than the other one. Thus forcing the shorter leg to bend down in order to reach the ground.
Adult heel pain and Children’s heel pain are not the same and are treated differently.
Symptoms of Sever's Disease
A child’s change in walking or abnormal gait due to tenderness and pain in either one or both heels is the most obvious sign of Sever’s disease. This usually occurs in the back. However, it is possible for the pain to also go down the sides and the bottom of the heel, right around the arch of the foot.
Other symptoms and problems of Sever's Disease may include:
- Difficulty with walking
- Discomfort if the heel is squeezed on both sides
- Redness or swelling of the heel
- When walking, the feet are stiff or discomforted
- Walking unusually, to avoid putting pressure on the heel by walking on one’s tiptoes or with a limp.
Doctor may recommend the following for Children with Acute Sever’s disease:
- Do leg and foot exercises that focus on strengthening and stretching leg tendons and muscles.
- Use a compression stocking – to decrease swelling and pain.
- Elevate the leg and apply ice (not directly to the skin). Do this for twenty minutes up to three times a day. It should be done even on days when the pain is not bad. This will help reduce the swelling.
- Ingest over-the-counter medications that focus on reducing swelling and pain. These include acetaminophen like Tylenol or ibuprofen like Advil and Motrin, not aspirin.
- Overweight or Obese Children – the odds are good that the doctor will recommend a weight loss regimen in order to decrease the pressure on the heel.
- If your child has a chronic or severe case of Sever’s disease, the doctor will recommend custom orthotic shoe inserts.
Proper Shoes for Pediatric Heel Pain
It is important that the child wear proper shoes. Find a pair that are good quality, shock absorbent, and are well fitted to help reduce the pressure. In more extreme cases, it may be a good idea to get open back shoes, as they do not rub on the heel. Avoid high heels and heavy shoes. After any and all activities, stretching exercises should be done and the affected heel should be iced.
Shoe Inserts and Orthotic Devices
A child with a pronated foot, high or flat arches, or other such conditions might receive a recommendation from the podiatrist for orthotic devices:
- Heel lifts that raise the heel and reduce the strain on the Achilles tendon.
- Arch supports made to keep the heel in a good position.
- Heel pads that protect and cushion the heel every time it strikes the ground.
Sever's Disease FAQ's
Sever’s disease is a painful inflammation of the growth plate in the heel bone of children, caused by excessive tension and repetitive stress on the heel.
The main symptoms are pain and tenderness in the heel and arch area. Swelling around the heel may also occur.
It is caused by repetitive micro-tears to the Achilles tendon where it attaches to the growth plate in the heel. Sports that involve running and jumping put added stress on the heel.
Sever’s disease typically affects active children between the ages of 8-15 years old. It is more common in boys than girls.
Traditional treatments include rest, ice, stretching, over-the-counter anti-inflammatories, and supportive shoe inserts. The Mikki Device offers an additional treatment option.
Limiting repetitive high-impact activities, using cushioned heel pads, stretching the calf muscles, and having regular foot exams during growth spurts can help prevent Sever’s disease.
Limiting activity is sometimes needed to allow the heel to rest and recover. However, The Mikki Device allows participation in sports to continue while treating Sever’s Disease at the same time.
Yes, Sever’s disease resolves itself once the heel bone stops growing. This may take 1-2 years in most kids.
It is possible to have recurrent episodes of Sever’s disease until growth plates close in the early teen years. Using preventive measures can reduce reoccurrence.
No, Sever’s disease does not lead to any long-term complications once the condition resolves as the child’s heel finishes growing.
Your Child's Feet Are Designed For Life
