Overview

Kids who play sports and develop a sore heel may have a common condition known as Sever’s disease. Repetitive stress on the heel’s growth plate can trigger painful inflammation. The clinical term for the condition is calcaneal apophysitis. It’s an inflammation of the growth plate in the heel.

Sever’s disease usually can be treated without surgery, though inflammation may reoccur while an active child is still growing.

Symptoms

The first symptom your child may notice with Sever’s disease is pain in the bottom or back of their heel. Sever’s disease may also cause redness and swelling in the affected heel. The whole foot can experience discomfort and stiffness in the morning.

Sever’s disease also may cause a limp or difficulty running and jumping. Your child may walk on their toes to compensate for the heel pain. The pain tends to worsen with activity and improve with rest.

Sever's disease symptoms usually develop in girls between the ages of 8 and 13 years, and in boys between the ages of 10 and 15 years. Children are less likely to develop Sever’s disease once their feet have stopped growing and their heels have hardened.

Causes

The foot is one of the fastest-growing parts of the body. It’s actually one of the first body parts to reach its adult size. The ligaments and tendons around the heel and foot don’t grow as quickly, though, so they may become overstretched and tightened with activity.

Additionally, the heel isn’t very flexible. That means it’s more vulnerable to injury from running and jumping on hard surfaces. Even playing sports on softer grass can be tough on the heel’s growth plate. All this puts the growth plate at risk for inflammation.

Risk factors

Kids who are still growing and active in sports have the highest risk of Sever’s disease. Sports that involve a lot of running and jumping, such as basketball, gymnastics, and track, pose the biggest risks.

Additional risk factors include:

  • standing for long periods of time, especially in shoes that don’t provide much padding or support
  • being obese or overweight
  • having flat feet or high arches
  • having one leg that is shorter than the other, known as short leg syndrome

How it’s diagnosed

During a physical exam, your pediatrician may squeeze the sides of your child’s heel. If that hurts, it could mean Sever’s disease. The doctor will also squeeze other parts of your child’s foot and ankle as part of a thorough physical examination.

X-rays may be needed after the exam. An X-ray can help rule out or confirm a fracture, but it can’t show Sever’s disease. Other imaging may be needed to look at the ligaments, tendons, and other tissue.

Treatment options

To treat this condition, your child will need to take a break from sports or other activities that may have caused the condition in the first place. The goal is to ease the strain on the heel. This can also be done with the help of orthotic shoe inserts to help support the heel.

The foot and ankle may need to be immobilized in a cast for several weeks in some cases. This includes if the inflammation is severe or if there are other injuries, such as a fracture or sprain.

For pain, a nonsteroidal anti-inflammatory drug, such as ibuprofen (Advil, Motrin), may be helpful. You can also wrap some ice in a thin towel and place it under the heel for about 20 minutes at a time three times per day. Icing may help reduce pain and inflammation more quickly.

Your pediatrician may also recommend physical therapy. A physical therapist will teach your child stretching and strengthening exercises.

What to expect from recovery

Usually it takes about two to three months to recover fully from Sever’s disease. In more severe cases, symptoms can last longer or come back.

While your child is still experiencing pain, they should refrain from activities that put strain on the heel. If physical therapy is needed, make sure your child does the exercises properly. You should also ask your child’s doctor about other activities they can do that don’t put a lot of pressure on the heel, such as swimming and bicycling.

It’s rare for Sever’s disease to cause serious complications.

Expected outlook

Once a child’s heel has hardened and stopped growing, the risk of Sever’s disease decreases significantly. Until that time, it’s possible to have multiple bouts of this inflammatory condition. If symptoms return, make sure your child sees a doctor. The heel pain could be from Sever’s disease or another foot problem entirely. Learn about other common causes of heel pain in children.

To help prevent Sever’s disease, make sure your child wears shoes with plenty of heel and arch support. The shoes should be appropriate for the sport or activity. Limiting your child’s time in cleats may also help preserve their heel health while they’re growing.

You should also make sure a child’s activities are appropriate for their age and ability. Playing basketball with older, bigger kids may put your child at risk for a variety of injuries, for example.

If you help your child maintain a healthy weight, you may also help reduce future episodes of Sever’s disease.

Sever’s disease can be painful and sideline your child for weeks or months, but with proper footwear and treatment, the outlook for a healthy recovery is good.