Sever’s Disease, also described as growth plate irritation, is a common cause of heel pain in children. It is often seen in young kids who are physically active or are experiencing a growth spurt. When young bones are rapidly growing there is a distinct line through them called the growth plate, where most of the new bone cells are formed. Due to a large amount of activity and growth occurring in this area, it can also make the bone prone to become sore.
During puberty, the calcaneus bone is divided by a large growth plate as shown in the image above. As the calcaneus grows faster than the surrounding soft tissue structures in kids, the Achilles tendon is pulled tight. This increase in tension can cause inflammation and irritation as the Achilles tendon tugs on the growth plate of the heel, leading to the formation of sever’s heel pain.
Who does Sever’s affect?
Sever’s disease is an injury which most commonly affects boys more than girls. It is most often diagnosed in boys around the age of 12-14 and girls aged 10-12, which corresponds with the early growth spurts of puberty. The age ranges of symptom onset can vary around these ranges, however it most commonly occurs within these timeframes. Sever’s disease affects children only. It is a condition which specifically involves the growth plate and surrounding structures in the foot that are not present in an adult’s foot.
What aggravates Sever’s?
Sever’s disease is worsened by physical activities especially those involving running and jumping. Typically kids who are very active by playing multiple sports with a high amount of time on their feet can develop this type of pain. Common causes of flare ups can include game time on firm pitches with soccer or football, as there is more force and pressure going through the feet.
Symptoms will commonly present at the same time as a growth spurt. This sudden growth gets compounded by either new sports or high impact existing activity, resulting in the tendon pulling with more force onto the bone. Growth spurts result in an imbalance between the bone and muscles growth, where tightness in calf and hamstring muscles can further irritate the area.
What does sever’s disease look like?
You’ll find on any x-ray of a younger child that you can see a clear line through the heel. The technical name for this line is the calcaneal apophysis (normal bone growth). When this area is inflamed it is then called calcaneal apophysitis (bone inflammation). This growth line is visible in children’s xrays for all heels as the growth plate is not associated with pain but rather normal healthy development.
For painful cases of sever’s disease it can be important to look more closely with a scan when pain is unresolving with corrective treatment. What is important is to check that there are no chips of bone that have come away through the growth plate, or that there is no soft tissue swelling present. If this is observed it can indicate that the structures around the growth plate have been irritated or injured and this would need to be managed with an alternative treatment. This would the extend beyond a growth plate issue, however the occurrence of this is rare.
The type of pain can vary from child to child. However there are some common patterns that are observed with sever’s disease in children. It is common for parents to notice their child is limping or running differently sometimes well before a child complains of pain. Kids really do seem to push through when they’re concentrated with their sport! For other kids they may be more vocal about what they are feeling and avoid activity because it simply just hurts.
Common presentations include:
- Soreness at the back of the heel in either one foot or both feet
- Heel pain during or after physical activity (with running or jumping type sports)
- Pain that extends up the back of the heel or under the foot arch
- Onset of pain has that has started after foot or leg injury, such as an ankle sprain
- A tender swelling or bulge on the heel
- Calf muscle stiffness first thing in the morning
- Avoidance of activity
Sever’s Heel Pain Treatment
Treatment in a simple sense involves taking pressure and strain off the foot to allow it to heal. The first priority is to reduce pain with walking. This is achieved through hands on treatment such as massage or shockwave therapy, in shoe-supports and strapping the feet. Once a child is able to walk comfortably, the Podiatrist will guide a childs return to higher impact activity including jumping and running pain-free. This ensures that the tendons and muscles around the growth plate are strong and stable, which will help to take pressure off the bone. After this occurs, a long-term approach is key so that pain not only goes away but stays away for good.
Common treatment strategies involve:
- Gentle stretching to loosen the calf muscle
- Heel lifts in the shoe to take pressure off the achilles insertion into the heel bone
- Applying ice to the painful areas for 10-15 minutes after sport
- Massage through the calves
- Shockwave therapy
- Strengthening calves and leg muscles through kid friendly home exercise programs
- Modifying agitating activities
- Taping the feet into a more efficient position
- Orthotic therapy to support the feet and offload the painful heel bone
- Recommendations for supportive shoes
Will Sever’s Disease get better?
It is important to note that while sever’s disease is technically a self-limiting condition with healing of the growth plate, it is necessary to seek treatment if walking or running is persistently too painful. As a parent, it can be concerning to see your child constantly limping or telling you that their foot is sore. Be rest assured that with the right medical care from a Podiatrist that they can safely be active and play sports again soon.
Podiatry treatment has a focus on getting pain down fast so that your child can continue to be active. A lot can be done both in the clinic and through guidance with sport and at-home exercises to reduce soreness quickly. It is through a guided approach that pain can settle quickly for your child and that it heals well so that it doesn’t last any longer than it needs to!
Sever’s is well managed when caught early.
When left untreated heel pain can persist and can lead to bony build up with prolonged discomfort. Worst of all it can lead to time off from sport!
If you are finding that your child is complaining of persistent pain over weeks or months, we advise you to seek medical advice from a qualified Podiatrist. A doctor referral is not required, you can simply book straight in.
If you have concerns with your child make sure to see a Podiatrist so they can get them back to 100%!