Heel Pain in Children

Sever’s Disease

What is Sever’s Disease?

Sever’s Disease is a common condition that causes heel pain in children, most typically beginning in girls aged 7-11 and boys aged 8-13. The condition is caused by excessive strain on the growth plate at the back of the heel bone as it nears its fully grown size.

What are the symptoms?
-Pain during, but particularly after sporting activity or running.
-Tenderness when pressure is applied at the back of the heel bone.
-Limping, or an unwillingness to put the heels down can sometimes be observed.

The symptoms can get better with rest, but return quickly when activity starts. Children particularly prone to Sever’s Disease are those with more strain on their feet. This includes children with tight calf muscles, flat feet, those who are very active, pigeon toed, kids who play sport on hard surfaces and children who are growing very quickly. Children with less stable feet often suffer from Severs Disease. This may be visible and their feet may seem to roll inwards (over pronate). It is often associated with less obvious structural problems within the feet and legs. A thorough assessment and correct diagnosis is always recommended.

What should be done about it?
It is normally bought on by exercise, which we do not want to discourage, and given this condition can last up to 4 years and in severe cases can result in fracturing of the growth plate, we recommend the first step is to have a thorough assessment. Sever’s disease responds very well to treatment in the great majority of cases, children can usually get back to full, pain free activity very soon after treatment is commenced.

What is the treatment?
Treatment is geared at relieving the strain on the growing heel bone by the following means:
-Wearing a small heel lift within the shoe.
-Very specific stretching of tight leg muscles. The stretches often depend on which part of the heel is painful.
-Supporting the foot if it is unstable. Orthotics may be recommended. These options will be discussed if required.
-Applying ice after activity or when the pain is present.
-Avoiding excessively flat shoes and unsupportive footwear.
-Avoiding uphill walking/running.

If there has been injury to the site such as a kick to the back of the heel, or if symptoms don’t quickly settle, an x-ray or other investigations may be advised.