Sever’s disease is a common, benign foot condition that primarily affects children between the ages of 8 – 15 with no long term negative effects. Also known as calcaneal apophysitis, Sever’s disease is the inflammation of the growth plate in the heel bone. It is a self-limiting “growing pain” which goes away when the child reaches skeletal maturity.
Immature bones are not fully ossified but rather have areas of cartilage where growth occurs to allow bony elongation or expansion. In growing athletes, the bone can lengthen at a rate at which the muscles cannot keep up. As a result, the muscle that attaches to the growth plate in the heel bone becomes very tight, and the most powerful tendon in the body, the Achilles, repetitively pulls on the growth plate. This results in inflammation and pain.
The condition is more common in very active children, particularly those who wear cleated shoes. Prolonged standing can bring on the pain. Certain foot shape variations can predispose to Sever’s disease, such as a very flat foot or the opposite, a foot with very high-arches.
Heel pain may extend into the Achilles tendon or the arch of the foot. Pain is often worse following activity. A child will often compete in an athletic event without limitations but experience intense pain later. Limping can occur. Pain improves after rest.
If the pain persists for several weeks, a consultation with an orthopedic specialist is recommended for appropriate diagnosis. Sever’s disease cannot be detected by x-ray, but often an x-ray is taken to rule out other causes of pain. The final diagnosis is made based on the symptoms, history and physical examination.
The initial goal of treatment is pain reduction. Rest is the most important element in recovery. Anti-inflammatory medications such as ibuprofen (Motrin®, Advil®) or naproxen (Aleve®) are very effective pain relievers, but should only be used for acute pain. Ice can be helpful as well. In severe cases, a patient’s foot will be put in a cast or cast-like boot (CAM boot) to reduce heel pressure and inflammation.
The patient can return to sports after the pain has resolved. However, recurrence is common unless the patient follows preventative management as outlined below:
- Stretching: As the cause of the pain is growth and a tight Achilles, stretching the Achilles is essential.
- Changing footwear: Cleats are a major source of the pain. Avoiding cleats or getting a more supportive or cushioned pair can be helpful. People with flat feet should consider certain types of shoes for pronation control and people with high arches should look into those designed for neutral distribution.
- Orthotics and inserts: Gel heel pads can help with the symptoms. In most cases, commercially available arch supports can be helpful. For more extreme conditions, such as severe flatfoot or high arches, a custom orthotic is recommended. Orthotics and inserts are about comfort and often there is some trial and error required to find the right one.
- Compression stockings are often supportive and help with the pain.
- Cross training and activity reduction: Limiting organized athletics to 3-4 hours per week can make a huge difference, even if it means cutting back on the schedule of weekly physical activities. Cross training – participating in activities that use different muscle groups and physical motions can also help decrease the risk of pain.