What is Sever’s Disease

Sever’s disease is a heel injury that is common among 8- to 14-year-old children. A child’s heel bone (calcaneal bone) grows until about age 14.

Until growth is complete, the area at the base of the heel bone (growth plate) can become inflamed when too much pressure is put on it. Because of the inflammation, Sever’s disease causes pain and tenderness.

Sever’s disease can occur in one or both heels. The condition is often triggered by physical activities that involve running and jumping on a hard surface.

During the activity, your child’s heel pounds on the ground, and the thick band of tissue that attaches to the calf muscles (Achilles tendon) pulls on the back of the heel.

What are the causes?

This condition is caused by inflammation of the growth plate.

What increases the risk?

Your child is more likely to develop this condition if he or she:

• Is physically active.
• Is starting a new sport.
• Is overweight.
• Has flat feet or high arches.
• Is a boy 10–12 years old.
• Is a girl 8–10 years old.

What are the signs or symptoms?

The most common symptom of this condition is pain on the bottom and in the back of the heel. Other signs and symptoms may include:

• Limping.
• Walking on tiptoes.
• Pain when the back of the heel is squeezed.

How is this diagnosed?

This condition is diagnosed based on a physical exam. This may include:

• Checking if your child’s Achilles tendon is tight.
• Squeezing the back of your child’s heel to see if that causes pain.
• Doing an X-ray of your child’s heel to rule out other problems.

How is this treated?

This condition may be treated with:

• Medicine that blocks inflammation and relieves pain.
• Cushions and inserts in the shoes to absorb impact from physical activity.
• Stretching exercises.
• A compression wrap or stocking. This will help with pain and swelling.
• A supportive walking boot to prevent movement and allow healing. This is rarely used.

Follow these instructions at home:

Medicines

• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• Do not give your child aspirin because it has been associated with Reye’s syndrome.

If your child has a boot:

• Have your child wear the boot as told by your child’s health care provider. Remove it only as told by your child’s health care provider.
• Loosen the boot if your child’s toes tingle, become numb, or turn cold and blue.
• Keep the boot clean.
• If the boot is not waterproof:
  • Do not let it get wet.
  • Cover it with a watertight covering when your child takes a bath or a shower.

Managing pain, stiffness, and swelling

• Apply ice to your child’s heel area.
  • Put ice in a plastic bag.
  • Place a towel between your child’s skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Have your child avoid activities that cause pain.
• Have your child wear a compression stocking as told by your child’s health care provider.

Activity

• Ask your child’s health care provider what activities your child may or may not do. Your child may need to stop all physical activities until inflammation of the heel bone goes away.
• Ask your child to do any physical therapy as told by the health care provider. This will stretch and lengthen the leg muscles. Have your child continue his or her physical therapy exercises at home as instructed by the physical therapist.

General instructions

• Feed your child a healthy diet to help your child lose weight, if necessary.
• Make sure your child wears cushioned shoes with good support. Ask your child’s health care provider about padded shoe inserts (orthotics).
• Do not let your child run or play in bare feet.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Your child’s symptoms are not getting better.
• Your child’s symptoms change or get worse.
• You notice any swelling or changes in skin color near your child’s heel.

Summary

• Sever’s disease is a heel injury that is common among 8- to 14-year-old children.
• A child’s heel bone (calcaneal bone) grows until about age 14. Until growth is complete, the area at the base of the heel bone (growth plate) can become inflamed when too much pressure is put on it.
• Sever’s disease is often triggered by physical activities that involve running and jumping on a hard surface.
• The most common symptom of this condition is pain on the bottom and in the back of the heel.
• Ask your child’s health care provider what activities your child may or may not do.