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Sever's disease

Sever's disease is the most common cause of heel pain in children between 8 and 14 years old. It is also called calcaneal apophysitis (cal-ca-nee-al ap-o-fy-sigh-tis). It is more common in children who are very active, and who play sports that involve a lot running and jumping.

Sever's disease is related to the growth changes happening in the heel bone. Children with Sever's disease will recover completely with no long-term problems.

What causes Sever's disease?

Image showing Severs disease, an inflamed growth plate in the heel bone, or calcaneus. The Achilles tendon attaches to the heel bone at the back of the footGrowth plates are areas of growing tissue near the ends of children's bones, where they make new bone tissue. Repeated stress on the heel from running and jumping can irritate the growth plate in a child's heel.

Other possible causes of Sever's disease include:

What are the symptoms?

Children with Sever's disease feel pain at the back of their heel. It usually starts and builds up gradually, and often the child will limp and feel pain during or after activity. Their heel may also be painful first thing in the morning and get better as they move around.

Sever's disease can affect one or both feet. The affected heel is usually tender, and squeezing the heel on both sides will cause pain. Sometimes the child's heel is swollen.

Your child's GP, physiotherapist, or podiatrist will diagnose Sever's disease by examining their heel. They will probably not need any special tests or X-rays. Their symptoms will usually improve within weeks if they follow the advice below, but may take months to completely go away. Symptoms can also come back if the child does a lot of the activity that originally caused them.

What can I and my child do?

Teenager doing up laces on sports shoes, which are best if they have Sever's diseaseYour child should wear shoes rather than going barefoot, as shoes absorb shock and reduce the impact on their heel. However, it's important to choose and wear the right shoes. Shoes should:

When children follow this advice, Sever's disease usually goes away and doesn't need any further treatment.

Who can help?

Your GP can check to see what is causing your child's heel pain. If your child has tried all the steps above and isn't getting better, your GP can refer them to a podiatrist or physiotherapist. If their symptoms get worse with rest, it's important to see your child's GP, who may refer them to an orthopaedic surgeon to find out if something else is causing the pain. Very few children with Sever's disease need surgery.

Your podiatrist will check their feet, legs, and the way they walk. They will also let you know which stretches, exercises, and footwear will help. They may also give your child heel raisers, shoe inserts, or orthotics, depending on how bad your child's pain is, their age, and foot shape.

A physiotherapist can help by telling you what stretches will help.

Often your podiatrist, physiotherapist, and GP will work together to get the best result.

Written by HealthInfo clinical advisers. Endorsed by podiatry liaison, Canterbury DHB. Updated August 2017.

Sources

See also:

Heel & foot pain

Page reference: 368551

Review key: HICLF-132158