Sever’s disease, also known as calcaneal apophysitis, is a common cause of heel pain in growing children and adolescents. It occurs during periods of rapid growth, typically affecting girls between the ages of 8 to 13 and boys between 10 to 15 years. This condition results from inflammation of the growth plate (apophysis) at the back of the calcaneus (heel bone), where the Achilles tendon attaches. During growth spurts, the bones often grow faster than the muscles and tendons, creating tension and stress on the heel’s growth plate, which has not yet fully matured. Sever’s disease is considered an overuse injury, commonly seen in active children who participate in sports or activities that involve running, jumping, and repetitive impact on the heel.
The primary cause of Sever’s disease is the repetitive stress placed on the heel bone during physical activities. Sports such as soccer, basketball, gymnastics, and track and field, which involve high-impact movements and sudden changes in direction, are common triggers. Additional factors that contribute to the condition include:
1. Growth spurts: During a rapid growth phase, the calcaneus can lengthen faster than the surrounding soft tissues, resulting in increased tension where the Achilles tendon inserts into the heel.
2. Poor foot biomechanics: Children with flat feet, high arches, or excessive pronation (inward rolling of the foot) are at a higher risk of developing Sever’s disease due to uneven distribution of pressure on the heel.
3. Inappropriate footwear: Wearing shoes without proper cushioning or arch support can increase the impact on the heel and exacerbate symptoms.
1. Heel pain: The hallmark symptom is pain at the back or bottom of the heel, typically worsened by physical activity and relieved with rest.
2. Tenderness when pressing the heel: The affected area is often tender to touch, and applying pressure may provoke discomfort.
3. Pain during impact activities: Running, jumping, or walking on hard surfaces can trigger or worsen the pain. In severe cases, children may limp or avoid bearing weight on the affected foot.
1. Rest and activity modification: Limiting or temporarily avoiding high-impact activities is crucial to reduce stress on the heel and allow the inflammation to subside. Low-impact activities such as swimming or cycling can help maintain fitness without aggravating symptoms.
2. Stretching and massage: Regular stretching of the calf muscles and Achilles tendon can help relieve tension on the heel. Massage of the calf and foot can also improve circulation and promote healing.
3. Foot orthotics: Custom or over-the-counter orthotic inserts with heel cushions or arch support can help distribute pressure more evenly across the foot and reduce impact on the growth plate.
With proper management, Sever’s disease typically resolves on its own once the growth plate matures and the child completes their growth phase. Early intervention and consistent treatment are key to minimizing pain and preventing long-term issues.