Children’s bodies are continually developing, which can lead to pain at the growth centres (or growth plates) in the body.
A common site of pain for children is in the heel and is known as Sever’s disease or calcaneal apophysitis.
As scary as the name may sound, it is not a disease, but an overuse condition.
Sever’s usually affects children between the ages of 8-15, when the growth plate of their heel is active and going through its final stages of development, although it has been reported in children as young as 5.
Due to its location at the very back of the heel, and with a strong Achilles tendon attaching to it, the growth plate is susceptible to irritation and inflammation.
What are some common symptoms?
♦ Unilateral or bilateral heel pain (one or both sided)
♦ Pain/tenderness in the heel (especially when squeezing the edges of the heel)
♦ Pain during exercise, particularly exercises involving running or jumping
♦ Limping or tendency to tip toe
♦ Calf muscle tightness first thing in the morning
What causes it?
Sever’s disease is a common cause of heel pain, particularly in the young and physically active. During puberty, the calcaneus (heel bone) consists of two areas of bone known as ossification centres. These two areas are divided by a growth plate which enables bone growth to occur, eventually fusing in adulthood. However, it also represents a site of weakness in the bone. The Achilles tendon attaches the calf muscle to the heel bone.
As a child grows the calcaneus grows at a faster rate than the surrounding structures, which means the Achilles tendon can become quite tight. This increase in tightness can cause inflammation and irritation of the growth plate which is known as Sever’s disease.
It is important to know that, although every child goes through the stage of having an open growth plate in their heels, not every child will develop pain.
Contributing factors to Sever’s disease
Children more likely to develop Sever’s may have:
♦ Tight calf muscles and Achilles tendon
♦ Flat feet / over-pronated feet / collapsing arches
♦ High arch feet
♦ Rapid increase in height
♦ Excessive weight
♦ Participate in explosive sports such as football, gymnastics or basketball
♦ Hard playing surfaces
♦ Sudden increase in activity (start of sport season)
♦ Poor footwear (lack of cushioning and support)
How we treat Sever’s disease
Here at Riverside Podiatry we have a paediatric-specific assessment so we can detect any abnormalities that may cause problems later in life. Having your children’s feet checked regularly can help these little feet live happier, healthier lives.
Our podiatrists have treated many young people with Sever’s disease. Each patient is different and there are often elusive biomechanical problems that exacerbate the traction on the growth plates of the heels.
Your podiatrist will develop a tailored treatment program which may include rest or activity modification, soft tissue treatment such as massage and stretching, and correction of biomechanics through heel raises or orthoses. In rare cases, where fragmentation of the apophysis exists and pain fails to subside with traditional treatment modalities, immobilisation of the foot and ankle with an air cast (moon boot or walking cast) is indicated.
When the biomechanical problems are addressed, we typically see a significant reduction in pain levels and a return to sport within a few days.