Sever?s disease is the most common cause of heel pain in the growing athlete and is due to overuse and repetitive microtrauma of growth plates in the heel. It occurs in children ages 7 to 15, with
the majority of patients presenting between 10 and 14 years of age. Sever?s disease will go away on its own when it is used less or when the bone is through growing, but it can recur (for example, at
the start of a new sports season). Traditionally, the only known cure was for children to outgrow the condition, with recurrences happening an average of 18 months before this occurs.
Apart from the age of the young person, other factors that may contribute to developing the disease may include; overuse or too much physical activity. Your child?s heel pain may be caused by
repeated stress on the heels (running and jumping activities), pressure on the back of the heel from too much standing or wearing poor-fitting shoes. This includes shoes that do not support or
provide enough padding for your child?s feet.
Most children with Sever's complain of pain in the heel that occurs during or after activity (typically running or jumping) and is usually relieved by rest. The pain may be worse when wearing cleats.
Sixty percent of children's with Sever's report experiencing pain in both heels.
In Sever's disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or
she runs or jumps. He or she may have a tendency to tiptoe. Your child's heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your doctor may also find that
your child's heel tendons have become tight.
Non Surgical Treatment
Treatment revolves around decreasing activity. Usual treatment has been putting children in a boot in slight equinus, or a cast with the foot in slight equinus, thereby decreasing the tension on the
heel cord, which in turn pulls on the growth plate at the heel. As the pain resolves, children are allowed to go back to full activities. Complete resolution may be delayed until growth of the foot
is complete (when the growth plate fuses to the rest of the bone of the heel). A soft cushioning heel raise is really important (this reduces the pull from the calf muscles on the growth plate and
increases the shock absorption, so the growth plate is not knocked around as much). The use of an ice pack after activity for 20mins is often useful for calcaneal apophysitis, this should be repeated
2 to 3 times a day. As a pronated foot is common in children with this problem, a discussion regarding the use of long term foot orthotics may be important. If the symptoms are bad enough and are not
responding to these measures, medication to help with inflammation may be needed. In some cases the lower limb may need to be put in a cast for 2-6 weeks to give it a good chance to heal.
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel.
Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and
inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a
cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence
of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle