Sever’s Disease (Calcaneal Apophysitis)

Sever’s disease is a common cause of heel pain in children, especially active ones. Despite the name, it’s really more of an injury than a disease. Calcaneal apophysitis (CAL-ca-NEEL a-PO-fi-SITE-us) is the clinical term. It means that your kid has inflammation in their heel bone (calcaneus) from putting frequent stress on it during activity. It’s a type of repetitive stress injury, and it heals with time and rest.

Sever’s disease affects children because their bones are softer at the ends where they’re growing (at the growth plate). New bone growth is made of cartilage, which is weaker and easier to injure. As children age, the cartilage hardens into bone. Apophysitis is inflammation of the growth plate of a bone in children. It’s very common — especially between ages 8 and 14, when growth spurts often happen.

Symptoms of Sever’s disease

Symptoms of Sever’s disease include:

• Pain in one or both heels (most children report pain in both heels)
• Pain when you squeeze the heel or put weight on it
• Discoloration or swelling in the heels
• Toe walking or limping, especially after running
• Stiffness at the heel, especially after sleeping

What causes Sever’s disease?

Like other repetitive strain injuries, calcaneal apophysitis happens gradually rather than all at once. It happens when frequent stress on your child’s heel starts to wear it down. This triggers inflammation, which causes pain and swelling. A tight Achilles tendon often contributes to Sever’s disease by pulling on the heel bone when it flexes. The tendon might be tight because bones can grow faster than tendons.

Inflammation is a healing process — it’s how our bodies repair injuries. But it needs time to do its work. If the stress on your child’s heel continues, the inflammation will also continue. Sometimes, the stress is just from normal walking, and there’s no practical way to avoid it. In other cases, practicing high-impact sports on hard surfaces may have contributed to Sever’s disease. Taking a break from them might help.

Other factors that may contribute include:

• Having flat feet
• Having childhood obesity

How doctors diagnose Sever’s disease

Doctors diagnose Sever’s disease with a physical exam. Your child’s doctor will apply gentle pressure to their heel and foot to determine where the pain is coming from. They might ask them to walk, run or jump. In some cases, they might order imaging tests, like X-rays or MRI, to help rule out other conditions. (For example, sometimes repetitive stress on your heel bone can cause a stress fracture.)

What are treatments for Sever’s disease?

Treatments for Sever’s disease include:

• Rest. Your child will need to take a break from vigorous activities for several days or weeks. Talk to your healthcare provider about how long they should rest and when to return to activity.
• Pain relief. Over-the-counter anti-inflammatory pain relievers, like NSAIDs, can help reduce pain and swelling. Ice also works well. Apply an ice pack for 15-minute intervals a few times a day.
• Orthotics. Your healthcare provider might recommend specialized footwear to relieve pain and pressure on your child’s heel. In some cases, they might recommend wearing a brace or splint.
• Physical therapy. Exercises that stretch your child’s Achilles tendon can help reduce strain on their heel. Exercises can also help strengthen the leg muscles that support the heel and foot.

What can I do to prevent Sever’s disease from returning?

If your child has recovered from Sever’s disease and is ready to return to activities, you might want to take some precautions to protect their heels going forward. Your healthcare provider might suggest:

• More appropriate shoes, especially for sports
• Daily stretches or warm-up exercises
• Losing weight if weight is a significant factor
• Staying alert to pain and stopping activities when it occurs

What can I expect if my child has Sever’s disease?

With rest and a chance to recover, the pain and inflammation in your child’s heel should soon begin to improve. Most kids can return to their former activities in a few weeks to months. Your healthcare provider can give you more specific guidance. If you can’t reduce the stress on your child’s heel, Sever’s disease may last until their bones are finished growing. This process is usually complete by age 15.