Now that fall sports are back in season, I’m seeing a significant increase in children with heel pain that is secondary to a condition called Sever’s Disease. It’s not actually a disease, but an inflammatory condition of the growth plate on the heel bone (calcaneous) medically termed calcaneal apophysitis. This occur’s most often in children aged 8-13 for girls and 10-15 for boys.
Calcaneal apohpysitis is the result of inflammation or irritation to the growth plate on the back of the heel bone. The pain will sometimes present on the bottom of the heel as well. This is not to be confused with plantar fasciitis which rarely occurs in children of this age. The inflammation is brought on by overuse in activity such running, jumping, or any repetitive pounding activity. Recently I had an 11 year old boy present with Sever’s disease that occurred from jumping into a shallow swimming pool and landing on his heel.
Often the child will be able to perform in their sport or activity with the pain, and present to mom or dad afterwards complaining of severe heel pain. Sometimes so severe they are crying. The condition then calms itself enough over the next several days to allow the child to continue playing only to then become inflamed again. It becomes a cyclic process.
The most important piece of information I relay to the parents of children with this condition is reassurance that nothing severe is going to happen. Many parents are so concerned that something is broken or badly injured. Once we establish what the condition is, it’s important to understand that it’s inflammatory and will respond to rest and conservative treatment. Initial treatment consists of:
- Ice – applying ice for 20-30 minutes to the heels after activity will help with inflammation
- NSAIDS – Advil (ibuprofen) taken according to recommended dosage for 7 days to several weeks can help reduce inflammation.
- Stretching – performing calf stretches 4-5 times a day to improve range of motion to the ankle which will take the stress off of the heel bone’s growth plate
- Cushion- running shoes can provide cushion and should be the shoe of choice at all times while dealing with this condition.
- Tuli’s Heel Cups – These are a unique heel cup that have a waffle like cushioned pattern that absorbs shock in the heel to reduce pain. They were created specifically for Sever’s disease. They are inexpensive and can be purchased at Amazon.
When all of the above treatment options have failed, I will sometimes recommend casting the child to slow them down and reduce the stress and impact on the heel. This is done for 2-3 weeks and most often is successful.
The most important point to realize with Sever’s disease is that it will eventually resolve and typically will not result in any severe or irreversible injury by allowing the child to continue to be active. I typically use the “listen to your body” rule. If tolerable, it’s ok to play. If the pain is so severe that running becomes hindered, activity should be stopped.