During a growth spurt, children can experience pain as the tendons, bone and cartilage grow. Sever’s disease is a common condition in growing children. It’s characterized by heel pain and can be relieved by both time (children outgrow this condition) and stretching the Achilles tendon. Sever’s disease is also called calcaneal apophysitis.
Sever’s disease is a common condition that causes heel pain in children. The pain worsens during high-impact sports and activities that put pressure on a growth plate in the heel. Growth plates are pieces of cartilage between the bones of children and adolescents. As we age, growth plates harden into bone.
Also called calcaneal apophysitis, Sever’s disease is actually an injury, not a disease. Children outgrow it with time. In the meantime, symptoms usually get better with rest, pain medication and proper footwear. To relieve the pain, doctors recommend exercises to stretch the Achilles tendon that connects to the heel.
While Sever’s disease is irritation of the calcaneus bone, Achilles tendinitis is irritation of the tendon that attaches to the calcaneus bone. Unlike Achilles tendinitis, Sever’s disease only occurs in children and adolescents.
The condition is named after the physician who first described it in 1912: Dr. James Warren Sever.
Sever’s disease is extremely common. It is one of the most prevalent reasons for heel pain in kids aged eight to 14.
Children and adolescents from age eight to 14 most commonly have Sever’s disease. Boys are slightly more likely to develop the condition than girls. Groups with a higher risk of Sever’s disease include children and adolescents who:
No. Sever’s disease specifically affects children.
Additionally, pain caused by Sever’s disease is different compared to pain caused by other foot conditions. In general, heel pain in adults is reduced with activity. With Sever’s disease, activity tends to make the pain worse.
Children develop Sever’s disease during a growth spurt, when the muscles, tendons, bones and cartilage grow quickly. As the bones and soft tissues grow and shift, they can be more vulnerable to injury.
Running and jumping puts stress on the Achilles tendon — the tough band of tissue that connects the calf muscle to the heel bone. This repeated stress causes swelling and pain in the growth plate where the Achilles tendon attaches to the back of the heel. As children age and the growth plate becomes solid bone, the heel and tendons can withstand more force.
For children with Sever’s disease, the most common symptom is pain in the back of the heel. The pain can cause children to walk on their toes or walk with a limp.
Sever’s disease can last until your child is fully grown. Once the growth plates close, the condition resolves itself.
There is no current evidence that suggests Sever’s disease is genetic. The condition is caused by repetitive stress to the heel.
No. Though Sever’s disease can be painful during the developmental years, it doesn’t cause long-term damage.
Doctors diagnose Sever’s disease with a physical exam. Your child’s doctor will apply gentle pressure to the heel and foot to determine which specific areas are causing the pain. X-rays or magnetic resonance imaging (MRI) may help your doctor confirm a diagnosis and rule out other conditions, such as a fracture (broken bone).
If your child has heel pain, swelling and tenderness that gets worse with high-impact activities, it may be Sever’s disease. Because the symptoms of Sever’s disease can be similar to other conditions, your child should see a doctor to find the cause of the pain.
Symptoms of Sever’s disease often improve with home treatments like rest and over-the-counter pain relievers. It can take a few months for symptoms to disappear completely. Treatment for Sever’s disease includes:
Physical therapy can be very beneficial for treatment of Sever’s disease. The therapist will set up specific exercises, like stretching, to help improve symptoms.
Side effects from NSAIDs can occur. They are rare and usually only affect people who have taken a medication for a long time. Side effects of NSAIDs can include:
Your family physician or pediatrician may recognize the symptoms of Sever’s disease. If rest and treatment doesn’t resolve pain, or if your child has developed severe pain, you may be referred to an orthopaedic specialist.
It may not be possible to prevent Sever’s disease, especially in very active children. To reduce the risk of your child developing the condition, you can help your child:
Most children and adolescents with Sever’s disease can manage their symptoms with conservative treatments. After children grow up, heel pain from Sever’s disease disappears when the growth plates turn into solid bone.
Your child shouldn’t participate in sports if they are in the middle of a flare-up. Use your best judgement and talk to your healthcare provider about which activities are safe for your child.
If your child has heel pain and swelling, you should see your doctor. While Sever’s disease is not serious, your doctor will perform an exam and may order an X-ray to rule out other conditions, such as a fracture.
A note from Cleveland Clinic
Sever’s disease isn’t serious, but it can be quite painful for your child. If your child is showing Sever’s disease symptoms, schedule a consultation with your healthcare provider right away. Prompt diagnosis and treatment can help manage the condition until your child outgrows it.
Last reviewed by a Cleveland Clinic medical professional on 09/07/2021.
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