Sever's Disease

Key points about Sever's disease in children

• Sever’s disease is a common cause of heel pain in active tamariki
• symptoms include heel pain, swelling, and difficulty walking
• it’s not a serious condition and usually resolves with rest, time and simple treatments
• treatment involves rest, ice and pain relief

What is Sever's disease? 

Sever’s disease, also known as calcaneal apophysitis, is the most common cause of heel pain in tamariki and rangatahi (young people). 

Sever’s disease happens when there is stress on the growth plate of the heel bone. Stress on the heel bone can occur with repetitive activities like running or jumping.

A bit about the heel 

The heel is the back part of the foot. The back of the foot includes the:

• heel bone (calcaneus)
• ankle bone (talus)  
• Achilles tendon (attaches the calf muscle to the heel bone)

Muscles, ligaments and tendons around the foot act like strong ropes to hold the bones together.

The below illustration looks at the parts of the lower leg.

What are the symptoms of Sever's disease?

Tamariki with Sever’s disease may experience:

• pain in one or both heels
• heel pain that comes on during physical activity
• heel pain that worsens after physical activity
• swelling in the heel

Tamariki with Sever’s disease may limp or walk on their tiptoes to avoid heel pain. 

Who gets Sever's disease? 

Sever’s disease usually affects tamariki aged between 8 and 12 years. It's more common in tamariki who are very active and play sports that involve a lot of running and jumping.

Sever’s disease is uncommon in older rangatahi as the heel bone usually finishes growing by 15 years of age.

What causes Sever's disease?

Sever’s disease is caused by repetitive stress to the growth plate of the heel bone. It most commonly occurs in active tamariki during growth spurts. During growth spurts, the bones, muscles and tendons are changing. 

The pain in Sever’s disease happens where the Achilles tendon attaches to the heel bone. This area can become sore and swollen. 

The illustration below shows the painful area in Sever’s disease.

When should I take my child to see a health professional? 

If your child has ongoing heel pain, take them to a health professional. The health professional will ask you questions and examine your child to work out the cause of their heel pain.

Will my child need any tests for Sever's disease? 

There are no specific tests to diagnose Sever’s disease. A health professional can diagnose Sever’s disease based on your child’s symptoms and by examining the foot. 

A health professional may arrange an x-ray for your child to rule out other causes of heel pain. 

See the KidsHealth page on x-rays to learn more.

What are the treatments for Sever's disease in children? 

Treatment for Sever’s disease focuses on managing pain and reducing inflammation. 

Rest and ice

Encourage your child to rest and avoid any activities that cause them heel pain. Putting ice on the heel for 15 to 20 minutes at a time may help relieve their pain. 

Physiotherapy

A physiotherapist can give your child exercises for the calf muscle and achilles tendon. These will help strengthen the muscles around the heel to relieve pain.

Footwear 

It is important that your child has supportive footwear, especially for sports and activity. A health professional may recommend your child has orthotics (such as gel heel cups) put in their shoes. Orthotics are special inserts that sit inside the shoe. Orthotics can help reduce the pressure on the heel. 

Pain relief

Short courses of pain relief medicine may be helpful for bad flares of pain, but pain relief shouldn’t be used for long periods of time. Talk to a health professional about how long and when to use pain relief.

Paracetamol

If your child has pain, you can give paracetamol to make them more comfortable. You must follow the dosage instructions on the bottle. It is dangerous to give more than the recommended dose.

Other medicine

If your doctor gives your child ibuprofen (such as Nurofen or Fenpaed), or if you buy it at the pharmacy, follow the dosage instructions carefully. It is dangerous to give more than the recommended dose. Never give your child aspirin, as this may increase the risk of Reye syndrome, which is a rare and serious illness.

What can I do to help my child with Sever's disease?

Here are some things you can try at home to help manage your child’s heel pain.

Monitor their activity

Ensure your child gets enough rest and avoids activities that worsen their heel pain. Help them slowly return to physical activities as their symptoms improve.

Prepare before activity

You can help your child prepare themselves before sports or activities. This includes making sure they have the right shoes for that activity. Also, encouraging them to stretch before and after any sports or activities can help. 

Exercises

The physiotherapist or health professional may give your child exercises to help strengthen the muscles around their heel. Encourage your child to do these regularly and build them into their routine.

How long does Sever's disease last? 

Sever’s disease usually resolves on its own as the growth plates finish developing. Sever's disease has gotten better in most tamariki by the time they are 15 years old. 

With the right treatment, symptoms often get better over a few weeks to months. But for some tamariki, pain can come back, especially if they return to activities too soon.

Tamariki will not have any long-term problems because of Sever’s disease.

When should I take my child to see a health professional urgently? 

See a health professional urgently if your child:

• has severe pain
• is unable to put any weight through their foot due to pain
• has injured their foot
• has ongoing pain despite having pain relief medicine
• has significant swelling, redness or heat around the foot area
• has a fever, loss of appetite or weight loss with the pain

If you are worried about your child for any reason, take them to a health professional.