Sever's Disease/Calcaneal Apophysitis
Sever's disease, or calcaneal apophysitis, is a common cause of heel pain among active children between 10 to 13 years old. This spontaneous heel pain results from injury to the heel bone’s growth plate which is caused by overuse rather than specific injury or trauma.
The condition is common among athletic children, particularly those active in soccer, football, and baseball. Treatment is available to reduce pain and discomfort associated with Sever's disease, but the condition usually resolves on its own once feet stop growing.
Causes of Sever's disease
Children are at a higher risk of developing Sever's disease when they are in the early stages of a growth spurt. During times of growth, muscles and tendons become extremely tight. Movements during athletic activities like soccer, tennis, and gymnastics can put added force on the growth plate in the heel, which is pulled tight by the Achilles tendon. Over time, the growth plate becomes inflamed and painful.
There are several other factors that can increase a child's risk of developing Sever's disease, including the following:
- Excessive pronation.
- Flat or high arches.
- Short Achilles tendon.
- Weight gain (which results in more force on the feet).
Sever's disease symptoms
The pain associated with Sever's disease is usually felt along the back of the heel and becomes worse when running or walking. In some children, the pain is so severe they may limp when walking.
One of the diagnostic tests for Sever's disease is the "squeeze test". Squeezing both sides of the heel together will produce immediate discomfort. Many children feel pain immediately upon waking and may have calf muscle stiffness in the morning.
Treatment of Sever's disease
Treatment of Sever's disease will depend upon the severity of the condition. Parents can assist with the treatment of Sever's disease by making sure their children reduce physical activity until some of the pain subsides. Losing weight can also help reduce pressure on the heel.
It is important to consult a doctor if the pain persists. A physician may recommend flexibility exercises, custom shoe inserts, or anti-inflammatory medication. In some cases, a splint or cast may be necessary to immobilize the foot and give it a chance to heal.
Most cases of Sever's disease will resolve by the age of 16, when growing subsides. Fortunately, there are no known long-term complications associated with the disease.