The large heel bone (called the calcaneus) has a growth plate at the back of the heel. This growth plate is made of soft cartilage and it gradually narrows and starts to turn into solid bone around 8
to 13 years of age. This growth plate is prone to becoming inflamed and painful at this time. The strong Achilles tendon happens to join onto the back of the heel bone and pulls on this growth plate
when running causing Sever?s disease.
Heel pain is very common in children due to the fact they are cnstantly growing. In most children, the heel bone (the calcaneus) is not fully developed until the age of 14 or older. Until then, new
bone is forming at the growth plate of the foot (the apophysis, located at the back of the heel), an area which is softer than others due to its role in accommodating the growth. Repetitive stress on
the growth plate due to walking, running and sports causes inflammation in the heel area. Because the heel's growth plate is sensitive, repeated running and pounding on hard surfaces can result in
pediatric heel pain. Children and adolescents who take part in a lot of sport are especially vulnerable. Over-pronation (fallen arches and rolling inwards of the feet) will increase the impact on the
growth plate and is therefore a significant cause and a major contributing factor to heel pain in children.
Sharp pain will be present in the affected heel (or both heels), especially while running or walking. Pain can be heightened following activity. The area will be tender to the touch and usually
becomes inflamed or reddened. It may also be painful to press on the heel with a finger from the back or to squeeze the sides together; the latter is particularly common. You might notice stiffness
in some of the surrounding muscles, making regular movements more difficult to achieve. This and the pain can manifest physically in abnormal practices like tiptoeing or limping. In some cases a lump
can be detected on the back of the heel, though it may be so small as to defy detection.
A doctor can usually tell that a child has Sever's disease based on the symptoms reported. To confirm the diagnosis, the doctor will probably examine the heels and ask about the child's activity
level and participation in sports. The doctor might also use the squeeze test, squeezing the back part of the heel from both sides at the same time to see if doing so causes pain. The doctor might
also ask the child to stand on tiptoes to see if that position causes pain. Although imaging tests such as X-rays generally are not that helpful in diagnosing Sever's disease, some doctors order them
to rule out other problems, such as fractures. Sever's disease cannot be seen on an X-ray.
Non Surgical Treatment
Decreasing or stopping sport is necessary until the pain reduces. Let pain be your guide, as it decreases you can slowly return to all activities. To help settle inflammation use an ice pack or rub
an ice cube over the
painful area for 5 minutes daily whilst pain persists. Wearing supportive trainers during the day can help to soften the impact of walking on the heel. Encourage a normal pattern of walking. Complete
the stretches below every day and before and after activity until your symptoms settle.
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel.
Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and
inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a
cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence
of 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