Has Heel Pain Sidelined Your Child? 7 Questions on Sever’s Disease, Answered

If your active school-age child complains of heel pain, you may chalk it up to ill-fitting shoes. But that may not be the whole story.

True, new shoes can cause heel pain. But physical activity — especially sports — can also trigger a problem called Sever’s disease, or pediatric calcaneal apophysitis.

It’s a scary-sounding mouthful. But the good news is, Sever’s disease is treatable and won’t cause lasting damage.

We asked podiatrist Christopher Herbert, DPM, to answer seven common questions about this childhood condition:

Q: What is Sever’s disease?

A: It’s a very common issue for younger children, involving the open growth plates in their heels, next to the Achilles tendon.

While Sever’s disease is temporary, kids can have it for several years until their growth plates close.

It usually develops between the ages of 8 and 14, but the timing can vary, depending on the child and how they grow.

Q: Are some sports more likely to cause it?

A: Any physical activity can irritate the growth plate in a growing child’s heel. Basketball is notorious for causing Sever’s disease, but football, soccer and track are common causes, too.

Any sport that requires a lot of jumping can trigger Sever’s disease, depending on how much kids practice or play sports.

Playing sports year-round can often set it off, since young bones do not have time to fully recover between sports seasons.

Q: What are the symptoms of Sever’s disease?

A: The foot or heel pain is different for each child. Some kids find it hard to walk, while others may just feel a slight ache in the heel.

Some kids will have a limp, while others will have significant difficulty walking at all.

Q: Are some kids at greater risk than others?

A: Yes. The kids who get Sever’s disease tend to have a high, rigid or stiff arch and often tight Achilles tendons. The problem can be structural and biomechanical.

Kids who have a flatter foot usually don’t get Sever’s disease as often. Their loose feet seem better able to absorb the shock of jumping.

Q: What is the treatment for Sever’s disease?

A: Kids typically feel better with reduced activity. We give them anti-inflammatory medication like ibuprofen (acetaminophen doesn’t work as well for this). That usually reduces symptoms.

We also have them apply ice over their sock and wear a heel cup if they’re still sore. This cushions the heel and provides added shock absorption.

If these measures don’t work, kids often have to use a walking boot to really reduce their activity.

In dramatic cases, kids have to stop playing sports and wear a fiberglass walking cast for two to four weeks. That usually takes care of it.

Q: Does heel pain ever return after treatment?

A: It can. We just have to look at why it’s happening.

To keep pain from coming back, kids can wear heel cups, take anti-inflammatory medication before playing their sport and maybe change their game or practice schedule a bit.

Custom-molded foot orthotics have proven to be beneficial in preventing recurrent heel pain.

The good news is that this condition goes away when the heel growth plate matures and fuses, and there is no long-term damage.

But Sever’s disease does cause a lot of pain and can be very debilitating for a sports season or two.

Q: Anything else parents should know?

A: We look at several different things during a physical exam for sports, but often neglect the feet and ankles.

But an issue like this can keep your child from playing sports normally.

The main thing to remember is that kids should not be having foot or ankle pain unless they have had an injury — like stepping on something and breaking a bone.

If your child notices foot pain or heel pain after exercising, have the doctor look at it.