Sever’s Disease: Pediatric Heel Pain

What is Sever’s Disease? This is not truly a “disease” at all, the true medical term is Calcaneal Apophysisits. These names are describing painful inflammation that occurs at the growth plate of the heel bone. It is the most common cause of heel pain in children ages 5-11.

This typically occurs in children between the ages of 8 and 14 years old. This is because the heel bone or calcaneus has not fully developed until at least the age of 14. While your heel bone is growing and developing new bone is forming at the growth plate.

When there is too mush stress on the growth plate, inflammation can develop. Overuse and stress on the heel often through participation in sports is a major cause of calcaneal apophysitis. The heel’s growth plate is sensitive to repeated running and pounding on hard surfaces like the ground. Children and adolescents involved in soccer, track and basketball are especially vulnerable.

Other potential causes include obesity, a tight Achilles and biomechanics problems both flat foot and hight arches.

Symptoms include:
– Pain in the back or bottom of the heel
– Limping
– Walking on toes
– Difficulty running, jumping or participating in usual activities or sports.
– Pain when sides of the heel are squeezed.

Diagnosis
To appropriately diagnoses the cause of the child’s heel pain and rule out other conditions, children with heel pain should be seen by a foot and ankle specialist. The examining podiatrist will ask questions about medical history and recent activities. The foot specialist will examine the child’s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging and studies may also be ordered.

Treatment
After evaluation there may be a combination of several treatment recommendations:
– Reduce activity
– Support the heel
– Anti-inflammatory medication
– Physical therapy
– Immobilization

Tips for prevention:
– Avoiding obesity
– Choosing well constructed, supportive shoes.
– Avoid or limited use of cleated athletic shoes.
– Avoiding activity beyond the child’s ability.

The right treatment plan is based on each individual child. Recurrent heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.

This information has been prepared by the consumer education committee of the American College of Foot and Ankle Surgeons.

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