Many children complain of heel pain that is worsened with physical activity. Such a complaint can actually be a condition called Sever’s disease. This condition is an irritation of the Achilles tendon (at the bottom of the calf muscle) as it attaches onto the heel bone (calcaneus). Severs disease is sometimes called calcaneal apophysitis. This condition usually occurs during rapid growth, often in the early stages of puberty. It is slightly more common in boys than girls and it generally occurs in children aged 7-14 years. Children with this condition will complain of pain in the heel of one or both feet and are usually tender to touch and may be swollen. They may also walk and run with a limp. Sever’s disease is common in sports that involve running and jumping, such as football.

Risk factors for Sever’s disease include tight calf muscles, weakness in the lower limb muscles, pronated (flat) feet, poor footwear and high levels of sport or other physical activity.

Children with Sever’s disease should be assessed by a physiotherapist to ascertain the contributing factors to this condition. Treatment may include the prescription of orthotics to create a better foot/ankle position, calf stretching, lower limb strengthening and modification of activity. Some children may require a heel raise in their shoes to reduce the load on their heel. Icing can also be helpful in the acute stage of this condition to decrease pain and swelling. Occasionally, medication will be required to settle the inflammation and decrease pain.

Sever’s disease is a self-limiting condition that will settle once the irritation resolves. In most cases the patient will have no pain and be able to return to sport anywhere between two weeks to two months. Patients should continue with a home exercise program including stretching and strengthening to prevent this condition occurring again.

 
References

Brukner, P., & Khan, K. (2007). Clinical Sports Medicine (3rd Ed.). Sydney: McGraw-Hill.
Micheli, L., & Ireland, M. (1987). Prevention and management of calcaneal apophysitis in children: an overuse syndrome. Journal of pediatric orthopedics, 7(1), 34-38.