Sever’s disease, also known as calcaneal apophysitis, is a common heel problem affecting children. This heel bone disorder is often painful, though it’s usually temporary and causes no long-term health effects. With Sever’s disease, the Achilles tendon repeatedly pulls on the heel’s growth plate, causing microtrauma (i.e. microfractures), inflammation, and swelling in the affected area. Sever’s disease is similar to Osgood-Schlatter disease, which affects the knee. Inappropriate footwear may be a contributing factor in the onset of this condition.
Sever’s disease is particularly prevalent among active children between ages 8 and 15. Young boys and girls who play soccer and other sports in which footwear is inappropriate—i.e. too narrow in the toe box, too rigid, etc.—are most commonly affected. Sever’s disease usually appears during the adolescent growth spurt—the 2-year period in early puberty where children grow the quickest. The adolescent growth spurt occurs between the ages of 8 and 13 in girls and 10 and 15 in boys. Teenagers over 15 years old rarely experience this heel problem, as heel bone growth is usually complete by this age. Sever’s disease usually self-resolves within 6 months of onset, though it can last longer.
Causes and Symptoms
The heel bone sometimes grows faster than the leg muscles (including the calf muscles) and tendons (including the Achilles tendon) during the early puberty growth spurt. The different growth rate in these structures can cause lower leg muscles and tendons to become overstretched and tight, which makes the heel less flexible and puts excessive pressure on the heel growth plate. The Achilles tendon, the strongest tendon in the body, attaches to the heel growth plate, and repetitive stress on this structure, especially if it’s already tight, can damage the growth plate, leading to tenderness, swelling, and pain.
Activities that involve running or jumping, such as soccer, gymnastics, track, and basketball, can place significant stress on a tight Achilles tendon and contribute to the onset of Sever’s disease. Ill-fitting shoes can also contribute to this health problem by failing to provide the right kind of support or by rubbing against the back of heel. The following factors may increase the likelihood of Sever’s disease in kids or young teens:
- Wearing footwear that is too narrow in the toe box
- Leg length inequality
- Obesity or carrying excess bodyweight
- Excessive foot and ankle pronation
Some of the most common signs and symptoms associated with Sever’s disease include:
- Heel pain or tenderness in one or both heels, usually at the back of the heel
- Pain or discomfort upon waking, or when the heel is squeezed
- Heel pain that is worse during or following activity
- Heel swelling or redness
- Tight calf muscles
- Decreased ankle range of motion
Sever’s disease will go away on its own with rest or after heel bone growth is complete, usually within 2 to 8 weeks after the heel pain or discomfort appears. Sever’s disease is not expected to cause long-term problems, though symptoms may linger for up to several years in severe cases. Certain conservative care measures may be helpful in treating this health problem, including:
- Avoiding activities that provoke pain or discomfort
- Elevating the leg while at rest
- Performing hamstring and calf muscle stretches two to three times per day
- Undergoing physical therapy
- Using cold therapy
- Using an elastic wrap or compression stocking
- Avoiding footwear with heel elevation, toe spring, and toe taper, and instead favoring footwear that’s completely flat and widest at the ends of the toes
More aggressive treatment measures, including over-the-counter anti-inflammatory medication (e.g. ibuprofen), steroid injections, and surgery, may be indicated in certain cases.
Addressing the footwear component of this health problem is an important part of a well-rounded Sever’s disease treatment plan. Optimal footwear for preventing or treating this problem is flat, wide (widest at the ends of the toes), and flexible in the sole. Open-back footwear (such as certain Crocs models) may be particularly helpful for kids and teens with Sever’s disease.
In his 18 years as a podiatrist, Dr. Ray McClanahan has learned that most foot problems can be corr...