HealthInfo Waitaha Canterbury
Sever's disease
Mate whakawaikura rekereke
Sever's disease is the most common cause of heel pain in tamariki (children) between 8 and 14 years old. It's also called calcaneal apophysitis (cal-ca-nee-al ap-o-fy-sigh-tis). It's more common in tamariki who are very active and who play sports that involve a lot running and jumping.
The pain usually improves within weeks with the simple measures described below and is gone within two to three months. It doesn't cause long term problems.
Causes of Sever's disease
Growth 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:
- being overweight
- having a tight Achilles tendon
- a lot of running and jumping in bare feet or on hard surfaces.
Symptoms of Sever's disease
Tamariki with Sever's disease feel pain at the back of their heel. It usually starts and builds up gradually, and often the tamaiti (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 affected heel is swollen.
Diagnosing Sever's disease
Your child's GP, physiotherapist or podiatrist will diagnose Sever's disease by examining their heel. They probably will not need any special tests or X-rays.
Helping my child with Sever's disease
- Applying ice to the affected heel can help to reduce swelling. Apply for 20 minutes after sports or any time they're feeling pain. Do this every three to four hours until their symptoms go away. Make sure you wrap the ice in a cloth and do not apply it directly to the skin.
- Pain-relief medicines such as ibuprofen and paracetamol can help to minimise pain. Make sure your tamaiti doesn't take more than the recommended dose for their weight.
- Your tamaiti should cut down or stop any activity that is causing pain and rest until the pain has gone. They can then go back to their normal activity, but rest again if the pain comes back. If the pain doesn't go away with rest, take them back to their GP for further investigation.
- Calf stretches are very effective in reducing the pain of Sever's disease. Your tamaiti should stretch each calf for 30 seconds three times a day (morning, night and after exercise). They should also do 10 to 15 reps of the static isotonic hold for 30 seconds each, three times a day. It's best to do this exercise on a step with a handrail so they can pull themselves up with their arms and avoid using their calves until they're doing the exercise.
Your tamaiti should wear shoes rather than going barefoot, as shoes absorb shock and reduce the impact on their heel. But it's important to choose and wear the right shoes. Shoes should:
- Be comfortable and fit well. Sports shoes are usually the best option.
- Have good support around the heel. They should have good cushioning in the heel and hold the heel firmly but comfortably. You can use gel inserts or heel raisers to achieve this.
- Have a slightly higher sole under the heel and thinner sole in the front of the foot. Raising the heel slightly reduces the strain on your child's heel.
When tamariki follow this advice, Sever's disease usually goes away and doesn't need any further treatment.
Getting help for Sever's disease
If the pain isn't getting better after doing the steps above, have your tamaiti child checked by a GP in case there is another cause.
A podiatrist can check your child's 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 tamaiti heel raisers, shoe inserts or orthotics, depending on how bad your child's pain is, their age and their 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. Last reviewed May 2022.
Sources
See also:
Review key: HICLF-132158
