If your young athlete complains of heel pain at the start of the winter sports season, there are a number of potential reasons for it. The most common cause of heel pain is plantar fasciitis, which occurs when the tough band of tissue on the sole of the foot becomes irritated and inflamed.
However, plantar fasciitis is not particularly common in children. There could be a different reason for your child’s heel pain. Ever heard of growing pains? They’re real, and Sever’s disease is one manifestation.
What Is Sever’s Disease?
Sever’s disease, also known as calcaneus apophysitis, is a condition that causes heel pain. Growing children and adolescents have areas on many of their bones called growth plates. Growth plates are made of cartilage but are replaced by bones as children get older and develop.
In a young person’s heel, the growth plate is where the Achilles tendon attaches to the heel bone (also called the calcaneus). Since the growth plate is made of cartilage and is softer than bone, it is at greater risk of damage than a normal bone. Sever’s disease is an irritation or inflammation of this growth plate on the calcaneus bone.
What Causes Sever’s Disease?
Sever’s disease is usually the result of overuse, such as the kind that’s common in sports that require running and jumping. The risk of Sever’s disease is increased when the Achilles tendon is tight, which pulls on the heel. Because the growth plate is softer than bone, it is more easily damaged.
Risk factors include:
- Certain foot and ankle anatomy issues
- A growth spurt
- Male gender
- Overweight or obesity
- Participation in athletics
What Are the Symptoms of Sever’s Disease?
Heel pain and tenderness is the hallmark of Sever’s disease. The pain is often worse with activity. Sometimes there will be mild swelling.
How Is Sever’s Disease Diagnosed?
I always start with a physical exam and medical history when a young patient comes to me with heel pain. It can be tricky to tell the difference between calcaneal apophysitis and plantar fasciitis, but plantar fasciitis is most common in people aged 45 to 64. If the patient is under 18 and has heel pain, it’s likely to be Sever’s disease.
During the physical exam, I’ll examine the child’s foot and press on the heel to see if he or she has pain. I may also want to watch the child walk to see if any symptoms present themselves. When taking a medical history, I’d like to know if the child plays sports, how often and if activity level has increased recently.
Imaging studies such as X-rays and magnetic resonance imaging are rarely necessary for diagnosing calcaneal apophysitis.
How Do You Treat Sever’s Disease?
In my experience, Sever’s disease does not need surgery to be treated. Conservative, nonoperative treatments are almost always enough to decrease pain and its effects on a young person’s life.
I have found that a dedicated program of stretching the calves is one of the best treatments for calcaneal apophysitis. Try some of these calf stretches, in sets of three, holding the stretch for 15 to 30 seconds each time. Stretching can be done every day—multiple times per day, if necessary.
Other Sever’s disease treatments can include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to help with the pain and inflammation
- Orthotics, which are shoe inserts that help cushion the feet
- Shoes with elevated heels, which may relieve some of the pressure on the growth plate
If your child is complaining of heel pain, I can help. Request an appointment with me or another foot and ankle specialist at Summit Medical Group Orthopedics. We can diagnose your child’s problem and take steps to solve it.