Sever's disease (sometimes called calcaneal apophysitis) causes pain in the heel. It is more common in children who are regularly involved in any sport activities involving running or jumping. It can usually be treated with rest, wearing supportive footwear for sports, and shoe inserts to support the heel. It is a harmless condition and usually gets better within a few weeks or a few months.
What are the symptoms of Sever's disease?
The typical symptom is pain at the back of the heel, or underneath it. The pain usually comes on gradually over a little while. It tends to become worse with walking, running or jumping. The pain may cause limping and walking on toes. There is usually difficulty with running, jumping or participating in any sports activities. The affected heel is usually tender and squeezing the heel on both sides causes pain. There may be pain with any movement of the ankle and the heel may become swollen.
The symptoms usually affect children between the ages of 7 and 14 years.
How is Sever's disease diagnosed?
Your doctor will usually be able to diagnose Sever's disease by taking a history of the symptoms and examining the foot and ankle. Investigations are not needed unless the diagnosis is not certain. Occasionally, investigations may be needed to rule out any other cause of the heel pain, such as X-rays, ultrasound, CT or MRI scan.
What is the treatment for Sever's disease?
The treatments used usually include simple measures to allow the heel pain to resolve. These treatments include the following:
- Advice on suitable footwear - especially footwear used for sports activities. Good supportive shoes are important for sporting activities, particularly for people who do a lot of running and/or jumping.
- Applying ice to the heel - may help to reduce the heel pain.
- Reducing activity - any particular activity causing the heel pain, especially any sports activity, should be stopped or reduced to allow the inflammation to resolve. This is usually only needed for a few weeks. Immobilising the lower leg and ankle in a plaster cast is occasionally needed if the pain is very severe but this is rarely needed.
- Supporting the heel - temporary shoe inserts or orthotic devices may provide support for the heel. It may be helpful to obtain advice about heel supports from a GP, pharmacist or podiatrist. A podiatrist is a person who is qualified to diagnose and treat foot disorders.
- Physiotherapy and exercises - suitable exercises may include stretching and strengthening the calf muscle (gastrocnemius) and tendon.
- Medicines - non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce the pain and inflammation.
There is no convincing evidence for any of these treatment options. So it is not known for sure what the best way of treating this condition is.
What is the outlook (prognosis) for Sever's disease?
Sever's disease usually gets completely better within 2-3 months. However, the condition may recur and need further treatment. The long-term outcome is excellent, as it does not cause any permanent problems.
What causes Sever's disease?
The symptoms usually affect children and young people when the heel bone (calcaneum or calcaneus) is not fully developed. The pain is due to overuse and repeated stress on the heel, and the recurring pulling by the tendon on the heel bone. This causes inflammation of the growing part (called the growth plate) of the heel bone.
The heel bone's growth plate is particularly sensitive to repeated running and pounding on hard surfaces. Therefore, regular participation in sports such as football, basketball or athletics may cause the problem. Other possible causes include being very overweight, and the tendon at the back of the heel (Achilles tendon) being very tight. Sever's disease is also more common if there are other foot problems such as flat feet or high-arched feet.
How common is Sever's disease?
It is not known exactly how common it is. However, Sever's disease is the most common cause of heel pain in children and adolescents. It can affect either one foot or both feet. This condition is more common in young people active in sport. It often seems to occur when there has been a stage of rapid growth (a growth spurt). It is uncommon once children have reached their full size (adult height). Boys are more often affected than girls.
Can Sever's disease be prevented?
The risk may be reduced by wearing well-made supportive shoes, especially for any sports activity.
Further reading and references
Tu P, Bytomski JR; Diagnosis of heel pain. Am Fam Physician. 2011 Oct 1584(8):909-16.
Elengard T, Karlsson J, Silbernagel KG; Aspects of treatment for posterior heel pain in young athletes. Open Access J Sports Med. 2010 Dec 61:223-32. doi: 10.2147/OAJSM.S15413.
Agyekum EK, Ma K; Heel pain: A systematic review. Chin J Traumatol. 201518(3):164-9.
Smith JM, Varacallo M; Sever's Disease. StatPearls Publishing 2018-2019.
Hussain S, Hussain K, Hussain S, et al; Sever's disease: a common cause of paediatric heel pain. BMJ Case Rep. 2013 May 272013. pii: bcr-2013-009758. doi: 10.1136/bcr-2013-009758.
James AM, Williams CM, Haines TP; "Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever's disease): a systematic review". J Foot Ankle Res. 2013 May 36(1):16. doi: 10.1186/1757-1146-6-16.
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