Sever’s Disease
How to Identify & Treat Sever's Disease
Sever’s Disease - The Most Common Cause of Heel Pain in Children
What is Sever's Disease?
Sever’s disease, also known as calcaneal apophysitis, is a painful inflamation 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).
"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. This condition, also referred to as Calcaneal Apophysitis, predominantly affects the growth plate in the heel bone of children between the ages of 6 and 16.
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. These changes can lead to compensatory tendinitis which can confuse the diagnosis."
How to Identify Sever's Disease
Heel pain on either one or both of the child's heels is the most obvious sign of Sever's.
(*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.)
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!
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.”
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.
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.
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.
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.
Pediatric Heel Pain
If a child is suffering from pediatric heel pain that affects both the bottom and back of the heel, then they may have a condition called (Sever’s Disease). This pain flares up every time the child does any activity on his or her feet. This means that they are affected whenever they are playing, walking, or even standing. A podiatrist may suggest foot exercises, bed rest, or orthotic devices to help relieve the pain. It is possible for Sever’s disease to heal quickly, but it can recur over the long term if there are no measures taken to protect the child’s heels, especially between the ages 8 to 15, the growing years.
FAQ for Sever’s Disease
Sever’s Disease, also known as calcaneal apophysitis, is a painful inflammation of the heel that typically occurs in children during their growth spurts. The condition arises when the heel bone grows faster than the surrounding muscles and tendons, leading to them becoming overstretched and tight. Girls may experience growth spurts that lead to Sever’s Disease between 7 – 13 years old, while boys may experience them around 10 – 15 years of age.
The most noticeable symptom of Sever’s Disease is heel pain, which may affect either one or both of the child’s heels. Other symptoms include a change in walking or gait due to tenderness and pain, redness or swelling of the heel, and discomfort when the heel is squeezed on both sides. However, for an official diagnosis, it is always best to consult a pediatric podiatrist or other children’s foot specialists.
Treatment options for Sever’s Disease depend on whether the condition is acute or chronic. For acute cases, conservative treatments such as leg elevation, icing the area, and rest are often sufficient. Over-the-counter medications can also help manage the pain. However, for chronic cases, a custom orthotic like The Mikki Device™ may be recommended. This device, designed specifically for children with Sever’s Disease, helps evenly distribute the weight, taking the pressure off the heel plate, and allowing it to heal.
All content on PediatricFootAnkle.com is written by or collaborated with Dr. Mikkel Jarman and meets our strict editorial guidelines which include fact checking and peer review. Learn more about our website content and resources policies here: Our Website Content & Resources Policy