As children reach their growth spurt in early puberty, the heel is one of the first body parts to grow to full size. Because children's bones are growing so fast, the muscles or tendons can't keep up and often become tight. The tight heel tendons can put a lot of stress on the heel, especially if a child is involved in athletics or other weight-bearing activity. Over time, too much pressure on the heel can injure it and result in Sever's disease, also called calcaneal apophysitis.
Facts about Sever's disease
Children are at greatest risk of developing Sever's disease when they have reached the early part of a growth spurt in early puberty. For girls, this is typically around ages 8 to 10. For boys, it happens somewhere between the ages of 10 to 12. By the age of 15, the back of the heel has typically stopped growing in most children, and Sever's disease becomes rare.
Any running or jumping activities can increase the odds that a child will develop Sever's disease. Soccer and gymnastics are two common sports that tend to put kids at risk.
Symptoms of Sever's disease
If your child has any of the following symptoms, call your pediatrician for an evaluation:
Heel pain that begins after starting a new sports season or a new sport
Walking with a limp or on tiptoes
Pain that increases with running or jumping
Heel tendon that feels tight
Pain when you squeeze the child's heel near the back
Pain in one or both heels
It is not difficult for a doctor to diagnose Sever's disease in a youngster or teenager. A personal history and a physical examination are usually all it takes to determine the cause of heel pain.
If your child is diagnosed with Sever's disease, treatment is fairly straightforward. He or she should avoid any activities that cause a flare-up of heel pain. Treat the pain with ice for 20 minutes, three times a day. If the pain is severe, over-the-counter pain relievers such as acetaminophen or ibuprofen can be used for a short period of time. (Don't use aspirin in a child or teen because it can result in a rare but life-threatening condition called Reye's syndrome.)
In some instances, a child might have other foot problems, as well, such as high arches, flat feet, or bowed legs. In these instances, your doctor can recommend an orthotic device to help further prevent the pain related to Sever's disease. One other simple tip that can prevent Sever's disease or speed along recovery is for your child to wear supportive shoes and avoid going barefoot as much as possible.
Prevention and recovery
Properly stretching to maintain flexibility is effective for preventing Sever's disease. Stretches should target the calves, heel cords, and hamstrings. Your child should do the appropriate stretches two or three times a day, holding the stretch for about 20 seconds each time. Ask your child's doctor for specific exercise instructions. Generally, doctors advise stretching both legs, even if the pain is confined to one heel.
It's also helpful to strengthen the shin muscles by having your youngster pull his toes in with a rubber exercise band or a piece of tubing and then stretch them forward. Assist your child in doing 15 repetitions of this exercise, three times a day.
Having your child wear shoes with good shock absorbers and avoid running on hard surfaces as much as possible should also help prevent the condition.
Online Medical Reviewer: Bass, Pat F. III, MD, MPH
Online Medical Reviewer: newMentor board-certified, academically affiliated clinician
Last Review Date: 11/02/2013
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