Severs disease is by far the most common cause of heel pain in young children, the condition commonly occurs in kids around the age of 10-15 years. Severs is a traction apophysitis in which
inflammation of the calcaneal apophysis (growth plate) occurs as a result of overuse or micro trauma. As mentioned severs disease is caused by micro trauma and over use, this can include excessive
foot pronation (foot rolling in), tight calf muscles, increase in sporting activities and inappropriate footwear. These all put extra sheering forces on the growth plate leading to aggravation and
resultant pain. Signs and symptoms of this include pain on squeezing of the heel, absence of swelling and redness, child describing pain as a dull ache, limping and pain with increased
Young athletes typically sustain the injury due to repeated stress caused by running and jumping. Partaking in any high speed sports can thus partly provoke the condition, such as football, rugby,
basketball, hockey or track athletics. Crucially the injury is linked to overuse, so exercising with fatigued leg muscles, without a suitable warm up, or beginning a new strenuous physical activity
are all risk factors. Placing excessive weight or pressure on the heel can also cause the injury. Another factor related to Sever's disease is overpronation, a biomechanical error that makes the foot
roll too far inwards.
The typical clinical presentation is an active child (aged 9-10 years) who complains of pain at the posterior heel that is made worse by sports, especially those involving running or jumping. The
onset is usually gradual. Often, the pain has been relieved somewhat with rest and consequently has been patiently monitored by the patient, parents, coaches, trainers, and family physicians, in the
expectation that it will resolve. When the pain continues to interfere with sports performance and then with daily activities, further consultation is sought. It should be kept in mind that failure
to instruct patients and parents that continual pain, significant swelling or redness, and fever are not signs of Sever disease and therefore require further evaluation could result in failure to
diagnose a condition with much more serious long-term consequences.
All medical diagnosis should be made by taking a full history, examining the patient then performing investigations. The problem usually occurs in boys who are going through or have just gone through
a growth spurt; one or both heels may be affected. Initially the pain may be intermittent occurring only during or after exercise. As the problem gets worse, pain may be present most of the time.
There may be swelling over the back of the heel and this area is painful if touched or knocked. On examination the patient often has flat feet, very tight legs muscles especially the
Non Surgical Treatment
Treatment includes modifying activities and resting to reduce pain and inflammation and take pressure off the growth center. Ice can also be very helpful in relieving symptoms, as well as
anti-inflammatory medication. A physical therapy program should be initiated to stretch tight calf muscles and strengthen the ankle muscles to relieve tension on the growth center. Shoes with padded
heel surfaces and good arch support can decrease pain. Cleats may need to be avoided for some time to help reduce symptoms. The doctor may also recommend gel heel cups or supportive shoe
Although Sever's disease generally heals quickly, it can recur if long-term measures are not taken to protect the heel during a child's growing years. One of the most important is to make sure that
kids wear proper shoes. Good quality, well-fitting shoes with shock-absorbent (padded) soles help to reduce pressure on the heel. The doctor may also recommend shoes with open backs, such as sandals
or clogs, that do not rub on the back of the heel. Shoes that are heavy or have high heels should be avoided. Other preventive measures include continued stretching exercises and icing of the
affected heel after activity.