Sever?s disease is particularly prevalent among active children between ages 8 and 15. Young boys and girls who play soccer and other sports in which footwear is inappropriate-i.e. too narrow in the
toe box, too rigid, etc. are most commonly affected. Sever?s disease usually appears during the adolescent growth spurt-the 2-year period in early puberty where children grow the quickest. The
adolescent growth spurt occurs between the ages of 8 and 13 in girls and 10 and 15 in boys. Teenagers over 15 years old rarely experience this heel problem, as heel bone growth is usually complete by
this age. Sever?s disease usually self-resolves within 6 months of onset, though it can last longer.
The pain of Severs usually occurs because of inflammation and micro-trauma to the growth plate of the heel bone. This can be caused by a sudden increase in activity, running on very hard surfaces, a
growth spurt, tight muscles or feet that roll in.
Symptoms of calcaneal apophysitis may include Pain in the back or bottom of the heel, Limping, Walking on toes, Difficulty running, jumping, or participating in usual activities or sports, Pain when
the sides of the heel are squeezed.
A physical exam of the heel will show tenderness over the back of the heel but not in the Achilles tendon or plantar fascia. There may be tightness in the calf muscle, which contributes to tension on
the heel. The tendons in the heel get stretched more in patients with flat feet. There is greater impact force on the heels of athletes with a high-arched, rigid foot.
Non Surgical Treatment
The doctor might recommend that a child with Sever's disease perform foot and leg exercises to stretch and strengthen the leg muscles and tendons, elevate and apply ice (wrapped in a towel, not
applied directly to the skin) to the injured heel for 20 minutes two or three times per day, even on days when the pain is not that bad, to help reduce swelling, use an elastic wrap or compression
stocking that is designed to help decrease pain and swelling, take an over-the-counter medicine to reduce pain and swelling, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Children
should not be given aspirin for pain due to the risk of a very serious illness called Reye syndrome. In very severe cases, the doctor might recommend that the child wear a cast for anywhere from 2 to
12 weeks to immobilize the foot so that it can heal.
Exercises that help to stretch the calf muscles and hamstrings are effective at treating Sever's disease. An exercise known as foot curling, in which the foot is pointed away from the body, then
curled toward the body in order to help stretch the muscles, has also proven to be very effective at treating Sever's disease. The curling exercise should be done in sets of 10 or 20 repetitions, and
repeated several times throughout the day.