Sever’s Disease (Heel)

Description

Sever’s disease is one of the most common causes of heel pain in growing, active children. It is an irritation of the growth area at the back of the heel bone, where the Achilles tendon attaches. It is not a serious injury.

How it happens (the mechanism)

Bones grow at special zones called growth plates. The main one, the physis, is what makes a bone longer. There is a second kind, called an apophysis — a growth center at a bony bump where a tendon anchors muscle to bone. The back of the heel bone — where the calf muscles attach through the Achilles tendon — carries one of these apophyses.

While a child is still growing, that apophysis is made of cartilage, not yet hardened into bone. Cartilage — the same rubbery material as in the ear or the tip of the nose — is softer than bone and weaker under tension. So when its muscle pulls hard or often, the apophysis is the part that complains.

During a growth spurt, the bones lengthen faster than the muscles can keep up, so the muscles become relatively tight and tug harder on the apophysis. Here, a tight calf pulls through the Achilles on the back of the heel with every running and jumping step. Day after day, that extra, sustained tension irritates and inflames the growth center — essentially the growing child’s version of the insertional tendinitis adults get where a tendon meets bone. The pain is inflammatory and can be surprisingly sharp. (In an older teen, a single explosive effort can occasionally pull the apophysis off as an avulsion fracture; the everyday version is this inflammation.)

Symptoms

Pain at the back or bottom of the heel, worse with running and jumping and better with rest, often during a growth spurt. Children may limp after sports or walk on their toes to take pressure off the heel. One or both heels can be affected.

Doctor examination and imaging

It is usually diagnosed from the exam — tenderness when the back of the heel is squeezed. X-rays are typically not needed at first, but may be used to rule out other causes, especially for one-sided pain that is not improving.

Treatment

Anti-inflammatory measures and ice after activity give relief, but the lasting fix is to stretch the muscle doing the pulling: gently lengthening the calf (and heel cord) a little each day takes tension off the growth area. Cushioned heel cups or supportive shoes help, and activity is safe as tolerated, easing off only when pain limits your child.

Recovery and long-term outlook

Sever’s is self-limiting and resolves as the heel’s growth area matures, in the early-to-mid teens, with no lasting harm.

When to call the doctor

Call if pain is severe or worsening, your child will not bear weight or use the leg at all, the area becomes very swollen, red, or warm, your child develops a fever, or things are not improving with rest as expected.

Learn more

OrthoInfo (AAOS) — Sever’s Disease: orthoinfo.aaos.org

This information is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. For specific concerns about your child, consult a board-certified, fellowship-trained pediatric orthopaedic surgeon.