Unlike adults, heel pain is very uncommon in children. When children do experience heel pain, it is highly likely to be caused by a disturbance to the growth plate in the backof the heel bone
(calcaneus), where the Achilles tendon attaches to the heel. This disturbance is known as Sever?s disease or calcaneal apophysitis (inflammation of the growth plate). Sever?s disease is most common
between the ages of 10 and 14 years, and it is one of several different ?osteochondroses? that may occur in other parts of the body, such as at the knee, such as Osgood-Schlatters Disease. This
condition occurs in children because they are still growing and their bodies harbor many ?growth plates?. A growth plate, also called an epiphyseal plate, is an area at the end of a developing bone
where cartilage cells change over time into bone cells. As this occurs, the growth plates expand and unite, which is how bones grow.
Sever disease is more common in children who do regular sports or exercise that puts pressure on the heels. Activities such as running and jumping can put stress on the tight muscles and
Children aged between 8 to 13 years of age can experience Sever?s disease with girls being normally younger and boys slightly older. Sever?s disease normally involves the back of the heel bone
becoming painful towards the end of intense or prolonged activity and can remain painful after the activity for a few hours. Severe cases can result in limping and pain that can even remain the next
morning after sport.
X-rays are normal in Sever's disease, but your doctor will probably get X-rays to rule out other problems. Treatment consists of non-steroidal anti-inflammatory medications and use of a heel lift to
relieve tension on the calcaneal apophysis. In more severe cases, phycical therapy consisting of modalities to relieve the pain, and stretching exercises may be helpful. In extreme cases, castings
have been used.
Non Surgical Treatment
Sever?s disease will go away on its own with rest or after heel bone growth is complete, usually within 2 to 8 weeks after the heel pain or discomfort appears. Sever?s disease is not expected to
cause long-term problems, though symptoms may linger for up to several years in severe cases. Certain conservative care measures may be helpful in treating this health problem, including avoiding
activities that provoke pain or discomfort, elevating the leg while at rest, performing hamstring and calf muscle stretches two to three times per day, undergoing physical therapy, using cold
therapy, using an elastic wrap or compression stocking, Avoiding footwear with heel elevation, toe spring, and toe taper, and instead favoring footwear that?s completely flat and widest at the ends
of the toes. More aggressive treatment measures, including over-the-counter anti-inflammatory medication (e.g. ibuprofen), steroid injections, and surgery, may be indicated in certain cases.
Addressing the footwear component of this health problem is an important part of a well-rounded Sever?s disease treatment plan. Optimal footwear for preventing or treating this problem is flat, wide
(widest at the ends of the toes), and flexible in the sole. Open-back footwear (such as certain Crocs models) may be particularly helpful for kids and teens with Sever?s disease.
Sever's disease may be prevented by maintaining good joint and muscle flexibility in the years leading up to, and during, their growth spurts (eg girls 8 to 10, boys 10 to 12). Foot arch problems
such as flat feet should be addressed after the age of five if they don't appear to be self-correcting. If you are concerned, please ask your health practitioner. The most important factor is the
amount of weight-bearing exercise your child is currently performing. Finally, LISTEN To Your Child! If your child is suffering heel pain between the ages of 8 to 12, suspect Sever's disease until
proven otherwise. Seek the professional opinion of your foot practitioner regarding its diagnosis and subsequent management.