What is Sever disease in children?

Sever disease occurs when the growth plate in 1 or both of your child’s heels becomes injured and inflamed. It's also called calcaneal apophysitis.

What causes Sever disease in a child?

As children reach their growth spurt in early puberty, the heel is one of the first body parts to grow to full size. Because children’s bones are growing so fast, the muscles or tendons can’t keep up and often become tight. The tight heel tendons can put a lot of stress on the heel. That’s especially true if your child takes part in sports or does other weight-bearing activities. Over time, too much pressure on the heel can injure it and result in Sever disease.

Which children are at risk for Sever disease?

Children are at greatest risk for Sever disease when they have reached the early part of a growth spurt in early puberty. For girls, this is around ages 8 to 10. For boys, it happens somewhere between ages 10 and 12. By age 15, the back of the heel has stopped growing in most children. Sever disease then becomes rare.

Any running or jumping activities can raise the odds that a child will get Sever disease. Soccer and gymnastics are common sports that tend to put children at risk.

What are the symptoms of Sever disease in a child?

These are common symptoms of Sever disease:

• Heel pain that begins after starting a new sport

• Walking with a limp or on tiptoes

• Pain that gets worse with running or jumping

• Heel tendon that feels tight

• Pain when you squeeze your child’s heel near the back

• Pain in 1 or both heels

• Swelling in 1 or both heels

How is Sever disease diagnosed in a child?

It's not hard for a healthcare provider to diagnose Sever disease in a child. A health history and a physical exam are usually all it takes to find the cause of heel pain.

How is Sever disease treated in a child?

If your child has Sever disease, treatment is straightforward. They shouldn't do any activities that cause a flare-up of heel pain. Your child may also need to:

• Use an ice pack. Ice the heel for 20 minutes, 3 times a day. To make an ice pack, put ice cubes in a plastic bag that seals at the top. Wrap the bag in a clean, thin towel or cloth. Never put ice or an ice pack directly on the skin.

• Use over-the-counter pain relievers.  Try pain relievers, such as acetaminophen or ibuprofen for a short period of time. Don’t give aspirin to a child or teen because it can result in a rare but life-threatening condition called Reye syndrome.

• Use an orthotic device to help prevent pain. Your child’s healthcare provider may recommend one if your child has other foot problems, such as high arches, flat feet, or bowed legs.

• Wear supportive shoes. As much as possible, your child should also not walk barefoot.

• Do stretching exercises. Your child's healthcare provider will show your child how to correctly stretch the calf tendon.

How can I help prevent Sever disease in my child?

Sever disease can be prevented. Have your child:

• Correctly stretch to stay flexible. Try stretches for the calves, heel cords, and hamstrings. Your child should stretch both legs 2 to 3 times a day, holding the stretch for about 20 seconds each time.

• Strengthen the shin muscles. Have your child pull his toes in with a rubber exercise band or a piece of tubing and then stretch them forward. Help your child do this exercise 15 times, 3 times a day.

• Wear shoes with good shock absorbers. Also tell your child not to run on hard surfaces, if possible.

Your child’s healthcare provider may also give you specific exercise instructions.

Key points about Sever disease in children

• Sever disease occurs when the heel bone in 1 or both of your child’s heels becomes injured and inflamed.

• Tight tendons in the heel lead to Sever disease. It often occurs during growth spurts in early puberty.

• Children who take part in sports, especially weight-bearing sports like soccer, are most at risk.

• Pain in the heel is the main symptom of Sever disease. Ice and an over-the-counter pain reliever can help ease it.

• Correctly stretching the muscles in the lower leg can help treat and prevent Sever disease. So, too, can wearing supportive shoes.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours, and on weekends and holidays. This is important if your child becomes ill and you have questions or need advice.