Sever's disease (sometimes called calcaneal apophysitis) causes pain in the heel. It usually affects children between 8 and 14 years old. It is more common in children who are regularly involved in any sport activities involving running or jumping. Sever's disease 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 is Sever's disease?
Sever's disease is a painful inflammation in the heel of the foot. It usually affects children between the ages of 8 and 14 years old when the heel bone (calcaneus) is not fully developed. Repeated stress on the heel (particularly sports activities such as running and jumping) causes inflammation of the growing part (called the growth plate) of the heel bone.
What causes Sever's disease?
Overuse and stress on the heel bone is the usual cause of Sever's disease. 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 or athletics may cause Sever's disease. 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. It can affect either one foot or both feet. Sever's disease is more common in young people active in sport. Sever's disease usually affects children and young people aged between 8 and 14 years. Boys are more often affected than girls.
What are the symptoms of Sever's disease?
The symptoms usually start and build up gradually. Sever's disease causes pain at the back or bottom of the heel. The pain 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.
How is Sever's disease diagnosed?
Your doctor will 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. Investigations to rule out any other cause of the heel pain may include X-rays, ultrasound and a CT or MRI scan.
What is the treatment for Sever's disease?
The treatments used for Sever's disease 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.
- 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 excercises may include stretching the calf muscle (gastrocnemius).
- Medicines - non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce the pain and inflammation.
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 Sever's disease does not cause any permanent problems.
Can Sever's disease be prevented?
The risk of developing Sever's disease can be reduced by wearing well-made supportive footwear, 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.
James AM, Williams CM, Haines TP; Heel raises versus prefabricated orthoses in the treatment of posterior heel pain associated with calcaneal apophysitis (Sever's Disease): a randomised control trial. J Foot Ankle Res. 2010 Mar 23:3.
Cassas KJ, Cassettari-Wayhs A; Childhood and adolescent sports-related overuse injuries. Am Fam Physician. 2006 Mar 1573(6):1014-22.
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.
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