Sever’s is one of the most common cause of heel pain in children.
Sever’s is a common finding during periods of growth spurts, especially in those who are very active and sporty. There often is an increased rise in occurrence when returning to school and increasing sport and high-intensity activity.
The pain comes from inflammation of the growth plate in the heel bone (calcaneum) this is caused by the repetitive pull of the Achilles tendon onto the heel bone which creates microtrauma to the growth plate.
Symptoms commonly present as gradual onset with pain and discomfort during and after high-intensity sport related activities, patients commonly describe this as a throbbing dull type pain, that stays local to the heel area. 60% of patients have symptoms affecting both heels.
Girls 8-13 years
Boys 10-15 years
Ages vary between girls and boys due rates of development differing
A Sudden increase of high levels of, high-intensity sport, such as running, football and rugby
Muscle Tightness in the calf muscles- causing traction on the heel bone
Poor unsupportive footwear
Diagnosis is primarily based on the clinical history, presentation, and assessment, imaging can be helpful.
Once the diagnosis has been made treatment in the early stages is based around reducing the load from the painful site. The use of a trainer or supportive shoe for daily activity with the application of a cold compress or ice for 10mins daily.
Rest from high loading activity to alternative low impact activity, is crucial this can be up to a period of 4weeks, a slow return to sport is recommended.
An Insole or orthotic can be beneficial mainly to reduce the load from the heel bone; which incorporates a heel raise or heel cushion. (see orthotics page for further details)
Stretching the tight muscles daily is vital.
Sever’s is usually self- limiting, resuming normal activities after 2-3months.
One study showed all patients treated with a specific program improved and could return to sport after 2 months.
Symptoms do occasionally in a small amount of patients.
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Hartree, N. (no date) Sever’s disease. Information about calcaneal apophysitis. Available at: http://patient.info/doctor/severs-disease (Accessed: 18 January 2016).
Hendrix, C. L. (2005) ‘Calcaneal apophysitis (sever disease)’, Clinics in Podiatric Medicine and Surgery, 22(1), pp. 55–62. doi: 10.1016/j.cpm.2004.08.011.
Micheli, L. J., and Ireland, M. L. (1987) ‘Prevention and management of Calcaneal Apophysitis in children’, Journal of Pediatric Orthopaedics, 7(1), pp. 34–38. doi: 10.1097/01241398-198701000-00007.
Scharfbillig, R. W., Jones, S. and Scutter, S. (2009) ‘Sever’s disease—Does it affect quality of life?’, The Foot, 19(1), pp. 36–43. doi: 10.1016/j.foot.2008.07.004.