Sever’s Disease Care for Growing Kids

What You Need To Know

Understanding Sever’s disease helps parents support their child’s recovery and return to play.

Pediatric Heel Pain and Sever’s Disease

Calcaneal apophysitis is a painful inflammation of the growth plate in the back of the heel bone (calcaneus). It typically affects children between the ages of 8 and 14, because the calcaneus is not fully developed until at least age 14. Until the growth plate (physis) closes, new bone is forming in this area and makes it weaker than the solid, adjacent bone of the calcaneus. When there is too much repetitive stress on the growth plate, inflammation can develop.

Calcaneal apophysitis is also known as Sever’s disease. It is the most common cause of heel pain in children, and it can occur in one or both feet. Unlike adult heel pain, which usually subsides after a period of walking, pediatric heel pain generally does not improve in this manner. In fact, walking typically makes the pain worse.

Symptoms may include pain in the back or bottom of the heel, limping, walking on toes to avoid pressure on the heel, difficulty running or jumping, pain when the sides of the heel are squeezed, and fatigue. Symptoms usually worsen with activity and improve with rest.

Overuse and stress on the heel bone through sports are a major cause. Children involved in soccer, track, basketball, and gymnastics are especially vulnerable. Other contributing factors include obesity, a tight Achilles tendon, biomechanical issues like flatfoot or high arches, and cleated athletic shoes. If your child is experiencing persistent heel pain, contact us to ensure a proper diagnosis and effective treatment plan.

Treatment, Recovery, and Prevention

To diagnose the cause of your child’s heel pain and rule out other more serious conditions, your doctor will obtain a thorough medical history and ask questions about recent activities. The foot and lower leg will be examined, and a squeeze test may be performed by applying gentle pressure to both sides of the heel. X-rays are often used to evaluate this condition, and in some cases MRI, ultrasound, CT scans, or laboratory tests may be ordered.

Treatment focuses on relieving pain, reducing inflammation, and preventing further irritation. Your doctor may recommend reducing activities that cause pain, applying ice for 15 to 20 minutes after activity, and using nonsteroidal anti-inflammatory medications such as ibuprofen. Temporary shoe inserts, heel cups, or custom orthotic devices can provide support. Stretching the Achilles tendon and calf muscles, along with physical therapy modalities like ultrasound, electrostimulation, and cold laser, is often helpful. In severe cases, a cast may be used to immobilize the foot and ankle while healing occurs.

Most children recover within 2 to 8 weeks with proper treatment and activity modification. The condition can return because the heel bone is still growing, so recurrence of heel pain should prompt another visit with your foot specialist.

To reduce the chances of heel pain, encourage stretching before and after activities, choose supportive shoes that fit properly, limit cleated athletic shoes, and avoid sudden increases in training. With the right care, children typically return to pain-free activity.