Children’s Heel Pain (Sever’s Disease)

Heel pain is a symptom that is often associated with older feet that have lots of hard miles on the odometer. But adults aren’t the only ones who deal with this common problem. Kids can too!

And while children can sometimes suffer the same sorts of injuries that befall their parents, such as plantar fasciitis, their heel pain is often caused by a condition that only affects kids—Sever’s disease, also known as calcaneal apophysitis. Although the symptoms can seem very similar to “adult” forms of heel pain, the causes (and therefore the most appropriate treatments) can be quite different.

A note to parents: If your child complains of heel pain, take it seriously! While most cases can be treated non-surgically, it’s important to get a firm diagnosis and take the appropriate treatment steps prescribed by a trusted foot and ankle expert. This helps ensure your child can return to play quickly, and does not damage their feet in ways that could lead to longer-lasting problems.

What Is Sever’s Disease?

Sever’s Disease is a very common inflammatory condition that typically affects children between the ages of 8 to 14. 

During those years, children are often going through many changes, including rapid increases in bone growth (growth spurts). The ends of many of their bones (including the heel bone) are capped by a “growth plate,” an area of softer tissue responsible for growing new bone. The growth plate is more susceptible to injury, irritation and inflammation than mature bone, and can be damaged due to overuse.

Sever’s disease can affect both heels simultaneously or be isolated to one heel.

Kids playing soccer

What Causes Sever’s Disease?

Sever’s disease is an overuse injury. Potential contributing factors include:

  • Playing sports, especially those that require a lot of running and jumping on hard surfaces.
  • Wearing shoes that don’t provide enough padding or support for the feet.
  • Standing for long periods of time.
  • Going through a growth spurt, which may result in relatively tight calves or Achilles tendons “pulling” on the heel.

During the winter months with less daylight and cooler temperatures, children often play either indoors or only during physical education class at school. Usually these areas have surfaces that are hard (tile or concrete) and the repetitive pounding of the heel bone on these hard surfaces causes muscle strain and inflammation around the heel.

Sometimes the symptoms of Sever’s Disease may not be identified until your child returns to their spring sports or becomes more active outdoors. With the gradual onset of inflammation over the winter months, your child adapts by placing less pressure on their heels. Once their activity level increases, however, the pain and discomfort become more obvious not only to the child but also to the untrained eye.

What Are the Main Symptoms of Sever’s Disease?

The symptoms of Sever’s disease may be very difficult to distinguish from other types of heel pain, such as plantar fasciitis, stress fractures, or bone abnormalities. So it’s always important to have an expert check your child’s heels.

That said, common signs of Sever’s disease may include:

  • Pain in the back or bottom of the heel
  • Pain when squeezing the sides of the heel bone
  • Limping
  • Walking on toes
  • Difficulty running, jumping or participating in usual activities or sports

Remember that a child may not always want to tell you when they are in pain, so you may have to watch for the signs yourself and ask them if they are struggling.

In some instances, an athletic coach may notice that a child is not giving 100% effort during practice or in a game. If the child has not communicated that they are experiencing any pain or discomfort, this behavior can be misinterpreted as loafing or disinterest. Coaches push their players to hustle. Without accurate information, they can easily pass negative judgement.

Be sure to establish a clear and honest line of communication with your child regarding their health and convey any issues that are limiting your child’s ability to their coaches.

Child doing foot exercises

How Is Sever’s Disease Treated?

The first step is to bring your child to the Heart of Texas Heel Pain Center here at Waco Foot & Ankle. With a thorough medical history and physical examination, we can identify or rule out other more serious causes of your child’s heel pain. 

X-rays are commonly used to evaluate your child’s feet to identify other conditions such as fractures or bone abnormalities. Sometimes additional testing will need to be performed through laboratory tests or advanced imaging studies (MRI, CT Scan).

Once we have a firm understanding of the problem, we can recommend a customized treatment plan. Potential treatment approaches might include:

  • Temporary rest from sports or strenuous exercise, and/or modifying activities to reduce the amount of high-impact exercise.
  • Immobilization via a cast or pneumatic walking boot, if necessary, to provide more protection during the healing process.
  • Use of orthotics, heel cushions, or other devices to support the heel and relieve excess pressure.
  • Stretching exercises to loosen and condition connected muscles and tendons that may be tugging on the heel bone.
  • Use of advanced nonsurgical therapies, such as MLS laser therapy, to stimulate accelerated pain relief and tissue healing processes within the body. (This can be especially helpful for a child who wants to return to their sports season as quickly as possible.)
  • Medications to deal with short-term painful symptoms.

How Do I Stop Sever’s Disease from Coming Back?

This condition is sometimes inevitable due to the activity and growth of your child. However, there are several steps your child can take to reduce the risk of future episodes, or at least make them shorter and less severe.

  • Make sure your child wears appropriately fitting and supportive shoes. This includes when they’re indoors, especially if you have tile, cement, or hardwood floors in high traffic areas. If we have prescribed custom orthotics, they should wear those consistently as well.
  • Make sure your child warms up before strenuous activity and cools down afterward. Calf stretches are particularly important.  Ask us for appropriate stretches for your child.
  • If your child starts to complain or you notice any of the above symptoms, seek treatment as soon as possible. Receiving care sooner rather than later can dramatically reduce both the severity and time of their treatment. We are here to get them back into their favorite sport or activity as soon as possible.

Remember, foot pain is not normal—no matter what age! If your child is struggling with heel pain, make sure he or she gets the care they need. Call Waco Foot & Ankle at (254) 776-6995, or request an appointment online today.

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