Sever’s Disease

Sever’s Disease is the common name for calcaneal apophysitis, one of the most common causes of heel pain in children aged 8-14 years.

It is the inflammation of the growth plate in the heel of growing children and is caused by repetitive stress to the heel - common in active children.

This page discusses the causes, symptoms and treatment options for children with this issue.

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Causes

Sever’s Disease occurs during the growth phase, at the insertion of the Achilles tendon into the area of the heel that is considered “active”. Between ages 8-14 years children go through this phase where the heel bone (calcareous) rapidly grows and transforms from cartilage into bone.

Pain, in the Achilles tendon at the point of attachment to the bone, is known as an apophysitis.

Symptoms

  1. Tendency to tip-toe

  2. The child may often be limping in the morning, during sport or after sport

  3. Posterior heel pain during/after physical activity, especially activities that require running and jumping

  4. The pain may worsen immediately after exercise or during exercise

  5. Pain may be exacerbated by pinching the heel in a pincer pinch motion

Diagnosis

Diagnosis of Sever’s disease done by our podiatrists follows a thorough history of the child’s presenting symptoms, medical and surgical issues, foot wear and daily activities. A physical examination of the posterior heel, weight and height of the child will also assist in confirming this.

In rare occasions medical imaging may be indicated to rule out other potential causes of the heel pain. Whilst Sever’s does not show up on an X-ray because the area is currently in the process of transforming from cartilage to bone, the x-ray will vary from no bone to spots of bone and cartilage (as above).

Other Contributing Factors

The frequency and duration of physical activity. Type of physical activity, that is whether it is high or low impact .

• Growth spurts: a rapid or sudden increase in height or weight affects it

• Inappropriate footwear fit and type

• Children's foot posture can readily exacerbate an issue

• Increased body weight or a high BMI (body mass index)

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