Sever’s Disease – how to help kids with heel pain

Sever’s Disease is a painful reaction in a growth plate at the back of the heel.

And although the name sounds concerning, it’s not really a disease! It’s just a normal process of growing that occurs in a majority of children.

Fast facts

Sever’s Disease tends to affect kids between 11-14 years of age as this is when they experience a rapid period of growth.

The reaction occurs in a small growth plate on the back of the heel. It reacts due to sustained traction or pull from the Achilles tendon during a significant growth spurt.

As the pain is linked to the rapid rate of growth, most episodes only last six months (about as long as the growth spurt.)

Sever’s Disease occurs simultaneously on both sides in the vast majority of cases, although one side may be worse than the other.


Managing Sever’s Disease

Severs Disease is caused by a constant pull on the active growth plate within the Calcaneus – the heel bone.

An active growth plate is a rubbery line of cells within the bone that produces new bone cells to enlarge the bone as we grow.

The most effective management approach is a combination of load reduction and pain relief.

Pain relief

Pain relief can be achieved with ice after exercise, applied directly to the heel, to reduce reactive soreness.

Topical anti inflammatory gels, such as Voltaren Gel, can be used during and after exercise but should only be used after discussing the situation with your Pharmacist.

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Heat cream, such as Dencorub, used during exercise are a way of distracting from the ache.

Adding heel raises in shoes, firm wedges of high density material, can be helpful by reducing the stretch on the calf muscle.

Load reduction

Load reduction is as easy as reducing the number and duration of sporting activities each week.

Start by removing a session of their least enjoyable sport and see if that’s enough to reduce symptoms.

If that’s ineffective, remove or reduce the duration of one additional session per week until the pain eases.

It’s worth noting that there’s no detrimental or long term change to the anatomy of the area as a result of ongoing load from activity.

This means that you can load the painful area as much as you like without worrying about long term issues.

So when you’re looking at reducing activity levels, remember the importance of psychological factors.

Often your child is torn between the pain and missing out on being involved in sport with friends.

So involve your child in the decision-making process and, if they’re happy to tolerate the symptoms, let them play.


Myths about Sever’s Disease

Vigorous calf stretching is counterproductive as it adds to the pull on the growth plate from the Achilles tendon. Additionally, calf stretches don’t alter muscle length.

To speed up the lengthening of muscle during the growth spurt, gentle strength exercises in lengthened positions are effective. An example would be a walking lunge exercise.

You DO NOT need ongoing treatment or orthotics!!!

This issue is a part of growing, and there are no detrimental effects if you ignore it.

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What else could it be?

Retrocalcaneal bursitis

Achilles tendinopathy

Calcaneal (heel) bone stress injury

Posterior ankle impingement

Achilles tendon tear, although this is quite rare in the 11-14 years age group.