If your child has recurring heel pain, they may have Sever’s disease (named for the doctor who classified the condition over a century ago). Although the name sounds frightening – to scare a parent, just add the word “disease” to any childhood condition – it’s actually fairly common and very treatable. In this post, we look at the condition’s causes, diagnosis, treatment, and prevention; in short, the ABCs of Sever’s disease.
What Is Sever’s Disease?
Put simply, Sever’s disease is when the growth plate in the heel (called the physis) becomes inflamed. The growth plate is exactly what it sounds like: the area where new bone grows. Just like the rest of the body, the heel bone (called the calcaneus) keeps growing throughout childhood and puberty. It doesn’t fully develop until the child reaches 14 or 15 years of age. Sever’s disease typically manifests between the ages of 8 and 14.
Repetitive stress on the growth plate may cause painful inflammation. This heel pain differs from the heel pain most adults experience. In adulthood, the simple act of walking helps alleviate most foot pain. Children living with Sever’s disease, however, typically experience greater pain when they walk.
What Are the Symptoms of Sever’s Disease?
The most common symptom of Sever’s disease is pain. Typically, this pain localizes in the bottom or back of the heel. You may notice your child limping, or walking on their toes, since walking normally is so painful. They may be unable to participate in activities or sports they used to enjoy, or may not perform as well as they used to. Your child may also feel pain when you squeeze the sides of the heel. They may also simply complain that they feel tired.
What Causes Sever’s Disease?
The most common cause of Sever’s disease is the child’s feet repeatedly striking hard surfaces, i.e. running on a court or field. This type of contact stresses the growth plate, causing inflammation. Kids who play sports like soccer and basketball, or who run track, are more likely to experience this type of inflammation.
Other causes include:
- High or flat arches
- Pronation, or a foot that “rolls” at the ankle when walking
- Short leg syndrome (i.e. one leg shorter than the other)
- Tight Achilles tendon
Diagnosing Sever’s Disease
Diagnosing Sever’s disease is a fairly straightforward process. After taking the child’s medical history, we talk about their activities, particularly any sports they play and how often. Next, we typically examine the child’s foot, lightly squeezing both sides of the heel to determine whether the child feels pain. We also look at whether the child feels pain when standing on tip-toe as well as flat on the ground. Finally, we may order x-rays or other diagnostic imagery to rule out acute injury, such as a fracture.
Sever’s Disease Treatment
There are two forms of Sever’s disease, acute and chronic. Treating the condition successfully requires first determining which form your child has. Luckily, neither acute nor chronic Sever’s disease requires surgery.
Acute Sever’s Disease
If your child has acute Sever’s disease, treatment mainly involves resting the foot to relieve the pressure that’s causing your child’s pain. Talk to your doctor to determine how long the rest period should last.
Additional treatments may include:
- Change in shoe gear
- Over-the-counter gel heel cups
- Reduced sports activities for one week
- A short course of over-the-counter anti-inflammatory medications, such as ibuprofen
Chronic Sever’s Disease
When acute care fails, a more aggressive treatment is called for. In this treatment, the podiatrist works with your child to change the way their foot hits the ground, alleviating pressure from the growth plate. This treatment uses a custom, ridged deep heel cup orthotic device to distribute pressure off and around the apophasis and stop the pain.
Your child wears this device in all of their shoe gear, including cleats and other athletic shoes. The treatment stops pain while allowing your child to remain active in their sport.
Treatment options for chronic Sever’s disease include:
- Custom orthotic with ridged deep heel cup
- Appropriate shoe gear
- Rare cases may require a cam boot or cast for 2 to 3 weeks to immobilize the foot completely
Can You Prevent Sever’s Disease?
The best way to protect your child against Sever’s disease is by ensuring they wear high quality, supportive shoes. This is especially true for when the child plays sports, but it applies at all times. Foot health starts with quality, well-fitting shoes.
Most of us were told at some point that we’d “grow into them” or “break them in” when we complained about uncomfortable shoes. The truth is, shoes should feel comfortable immediately, no matter what age you are. Talk to your podiatrist or pediatrician about properly sizing your child’s foot. If you buy shoes online, first go to a physical store to try on shoes, making note of the size and style that feels and fits best.
If your child participates in strenuous activities such as soccer, track, or basketball, make sure they stretch afterward. And, if they feel heel pain, elevate and apply ice as needed (but never directly on the skin).
Your podiatrist may recommend orthotics, especially if your child has high or low arches or a pronated foot. These devices are custom-made for your child’s unique foot and needs.
The Final Diagnosis
The pain children experience with Sever’s disease can be extreme. Don’t ignore it. Although children eventually outgrow the condition, it will continue unless treated. If your child is limping or otherwise walking abnormally, schedule an appointment with your podiatrist or pediatrician to help determine the cause.