Two heels and a person holding one heel School is well and truly back! The last thing you want is your child to be in pain as they start the new year. Has your child complained about pain in their heels especially after a big day of sport or after a Phys Ed class?

They could be suffering from a common condition called Sever’s Disease.

What is Sever’s?

One of the most common causes of heel pain in children is calcaneal apophysitis more commonly known as Sever’s. Typically, this condition affects children aged between 8 and 15 tending towards the more athletic/ active children with a recorded incidence rate of 3.7/1000 patients.

Sever’s generally presents with pain and inflammation at the back of one or both heels with pain aggravated during activity usually involving running or jumping.

Pain sometimes persisting for some time following activity. If not treated the pain levels can be quite high and uncomfortable sometimes preventing the participation in sport or activities of daily living.

Anatomy of the heel in Sever’s

Figure 1: Anatomy of Severs
Figure 1: Anatomy of Severs

The bones in Children’s feet are not completely fused together when they are born, many in 2 or 3 sections.

Over the years as the child grows these sections fuse together to form one bone.

At the back of the heel where the Achilles tendon inserts into the bone, there is one of these areas known as an apophysis.

This is an open growth plate not closing completely until around the age of 14.

Irritation and stress especially with a tight Achilles tendon pulling on this on this growth plate is the main cause of the inflammation and pain experienced.

Causes of Sever’s

The main theory behind the cause of Sever’s is due to mechanical overuse while the growth plate is still open. This can be due to increased or high levels of activity causing repetitive stress and the development of inflammation.

Obesity can also play a role as this puts more stress through the legs and feet. Patients often have no specific injury history when presenting with pain however tend to have poor dorsiflexion through their ankles leading to a tighter pull on the growth plate of the calcaneus.

Treatment

In most cases the general treatment for Sever’s is conservative.

Man performing an Achilles stretch
Figure 2: Man performing an Achilles stretch

These treatment options include;

  • Ice therapy,
  • Modifying current activity levels,
  • Exercises and stretching to reduce tension on the Achilles tendon,
  • Anti-inflammatory medications,
  • Taping the heel and arch,
  • Shoe inserts including gel heel cups for extra cushioning and shock absorption.

There is also the option to use an immobilization boot in severe cases or where the patients may not be too compliant with other treatment options.

This boot would be used in conjunction with other therapies. Recovery time for Sever’s will vary among children. The younger the child is when diagnosed the longer the recovery period may be.

Treatment compliance and the amount of activity reduction will also play a role in the recovery time. Generally full recovery will occur at the age of skeletal maturity where the calcaneus bone is fully fused.

 

Written by Podiatrist, Thomas Abraham

Areas Treated: Foot, Ankle, Knee, Toenail Care

Tom graduated from the Queensland University of Technology with a Bachelor of Podiatry. Since leaving university he has gained an interest in sports injuries, biomechanics and wound care and is always looking to learn more allowing him to provide the best treatment he can. Tom has also spent some time working with running footwear specifically ASICS.

During school and university, Tom was actively involved in playing soccer, tennis and completed in athletics up to a state-level on a few occasions. Tom is a keen traveler spending a year in Europe in and some time in Nepal volunteering and completing the Everest base camp trek. In Tom’s spare time he enjoys snowboarding when he can.

Tom is available for Podiatry appointments at our Chermside, North Lakes and Redcliffe locations.