As a parent, it’s always worrying to see your child experiencing physical pain, especially during their growth phase.
One common cause of heel pain in children is Sever’s disease, a relatively frequent but lesser-known condition that mainly affects active kids. If your child plays sports like soccer, basketball, or runs regularly, they may be more vulnerable to this condition, also known as calcaneal apophysitis. The good news is that with proper management and a few changes to their daily habits, it is entirely possible to manage and relieve this condition.
Sever’s disease is closely linked to the rapid growth that occurs in children between the ages of 8 and 15. During this period, the bones, muscles, and tendons grow at different rates. The Achilles tendon, in particular, undergoes significant stress, especially in children involved in sports that require repeated jumping or running. The growth plate, located at the back of the heel (or calcaneus), is the sensitive area affected in this condition. Since the cartilage in this region is not yet fully developed, it is particularly vulnerable to repeated microtrauma.
What is Sever’s Disease?
Sever’s disease is an inflammation of the growth plate in the heel, known as the growth cartilage. When a child or adolescent engages in intense physical activity, this area can become irritated due to repeated pulling by the Achilles tendon on the calcaneus. The resulting inflammation causes heel pain that can make walking, running, or even standing painful. This condition often affects children and teens who are in the midst of a growth spurt, as their bodies undergo significant changes.
The name “Sever’s disease” comes from Dr. James Warren Sever, who identified the condition in 1912. While Sever’s disease may seem alarming, it’s important to note that it does not cause permanent damage and typically resolves once the growth plate fully ossifies.
Main Causes and Risk Factors
Children who regularly engage in sports are particularly at risk of developing this condition. The repetition of intense movements, such as jumping, sprinting, and sudden stopping, puts significant pressure on the Achilles tendon, which pulls on the growth plate in the heel. This excessive tension leads to inflammation, hence the pain felt by the child.
However, sports activity is not the only cause, other factors can increase the risk of developing Sever’s disease:
Inadequate footwear: Children who wear shoes that don’t properly support their feet are more likely to develop this condition. Shoes with poor cushioning or insufficient arch support can exacerbate heel pain.
Overweight: Excess weight can also play a significant role. The heel has to bear extra weight, which increases pressure on the growth plate.
Flat feet or high arches: Children with flat feet or very high arches are at higher risk. These foot anomalies can change the way the foot absorbs shock, increasing pressure on the heel.
Rapid growth: During periods of rapid growth, bones sometimes grow faster than muscles and tendons. This imbalance creates tension on still-developing structures, especially the calcaneus.
Recognizing the Symptoms of Sever’s Disease
Sever’s disease primarily manifests as heel pain located at the back of the foot. Children with this condition often experience sharp pain after physical activities such as running, soccer, or even after a particularly active school day.
The most common symptoms include:
Heel pain: The pain is often felt in one or both heels and worsens during activities like walking, running, or jumping.
Stiffness and tenderness: The heel may become stiff, especially after resting. Many children complain of pain after sitting or a night’s sleep.
Limping: To avoid feeling pain, the child may limp or adopt a particular gait, often walking on their toes to reduce pressure on the heel.
It’s important to note that the pain is temporary and that Sever’s disease does not cause long-term damage. However, managing the pain and limiting activities that could worsen the symptoms is essential.
Diagnosing Sever’s Disease
The diagnosis of Sever’s disease is usually made by a podiatrist or general practitioner, based on a combination of physical examination and observation of symptoms. No imaging tests are necessary, but the practitioner may sometimes order an X-ray to rule out other potential causes of heel pain, such as a fracture or bone tumor.
During the clinical exam, the doctor will apply slight pressure on the heel to assess the area’s sensitivity. If the child responds with significant pain in the growth plate area, Sever’s disease is likely the cause.
Treating and Managing Sever’s Disease
Although there is no specific cure for Sever’s disease, a conservative approach and adjustments to daily activities can greatly relieve the pain and allow the child to safely return to sports.
Treatment often begins with rest. It’s crucial to reduce or even temporarily eliminate intense physical activities that heavily strain the Achilles tendon and heel. Applying ice to the affected area for 10 to 15 minutes after activity or at the end of the day can also help reduce inflammation.
Wearing appropriate shoes is also crucial. Shoes with good cushioning, arch support, and custom orthopedic insoles can help absorb shock and reduce pressure on the growth plate. In some cases, the podiatrist may recommend orthotics to correct gait imbalances and provide additional support.
Finally, regular stretching exercises, aimed at loosening the Achilles tendon and strengthening the calf muscles, are often recommended. These exercises help relieve tension on the heel and prevent recurrence.
Preventing Sever’s Disease
While it’s difficult to completely prevent Sever’s disease in growing children, certain precautions can reduce the risk. Choosing the right shoes is a key factor: shoes that properly support the arch, absorb shock, and offer good stability are essential, especially for young athletes.
It’s also recommended to encourage regular stretching of muscles and tendons before and after physical activities. These exercises help reduce tension on the Achilles tendon and protect the heel from microtrauma.
Conclusion Sever’s Disease
Sever’s disease may seem alarming to parents, but it is one of many growth-related conditions. If properly managed, this condition leaves no long-term consequences. With simple measures such as rest, appropriate footwear, and regular stretching, heel pain can be significantly reduced, allowing the child to resume their usual activities without risk.
If in doubt or if the pain persists, it’s always advisable to consult a podiatrist or doctor. Early diagnosis and good management are key to ensuring your child’s health and well-being.
