Sever’s disease or calcaneal apophysistis sends many athletic children limping into my office. It is common in children between 10 and 13 years of age. Most children complain of pain in both heels that is relieved by toe walking.
Sometimes a child’s bone growth takes place at a much faster rate than the tendons. This can produce a relative shortening of the heel-cord compared to the leg bones. The end result is an overuse syndrome of injury, inflammation, and pain to the growth plates at the back of the heel bone.
X-rays are usually normal in Sever’s disease, but are usually taken to rule out other problems like bone cysts. In severe cases X-rays may show the growth plate detaching from the heel bone or fracture. Casting is the best treatment option if this is suspected. Sever’s is similar to Osgood Schlatters disease of the knee, which occurs in slightly older children. Both conditions respond well to orthotic therapy (prescription arch supports). This prevents excessive motion and helps realign the biomechanical structure of the foot.
Other treatments for Sever’s disease include ibuprofen, stretching, taping, heel cups, and heel lifts. Resting the heel is important, but this is hard to achieve with an active child. Most children return to sporting activity within two months. Heel pain from Sever’s usually resolves when growth in the heel bone is complete at about age 13.