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Heel Pain (Severs)

Foot & Ankle Care of Colorado

What is Severs?

Calcaneal apophysitis, often referred to as Sever’s disease, is an inflammatory condition affecting the growth plate of the heel. This condition primarily affects children aged 8 to 14 years old, as their heel bones (calcaneus) are still developing. The growth plate, or physis, located at the back of the heel, is particularly vulnerable during this growth phase. Repetitive stress on the growth plate, such as from sports activities or physical exertion, can lead to inflammation and pain.

Causes of Severs

Calcaneal apophysitis, commonly seen in children and adolescents, is primarily attributed to repetitive stress and overuse of the heel bone, particularly during sports activities. The growth plate in the heel is particularly sensitive to the impact and strain generated by activities like running and playing on hard surfaces. This repetitive stress can lead to muscle strain and inflammation of the tissues surrounding the growth plate. Therefore, young individuals engaged in sports such as soccer, track, or basketball are particularly susceptible.

Additional factors contributing to calcaneal apophysitis include conditions like obesity, which increases the load on the heel bone, as well as a tight Achilles tendon that can exacerbate tension on the growth plate. Biomechanical issues such as flatfoot or high-arched foot can also alter foot mechanics, further predisposing to heel pain and inflammation in susceptible individuals. Identifying and addressing these factors early is crucial in managing and preventing the progression of calcaneal apophysitis in young athletes.

Severs Symptoms

Symptoms of calcaneal apophysitis may include:

  • Pain in the back or bottom of the heel
  • Limping
  • Walking on toes
  • Difficulty running, jumping or participating in usual activities or sports
  • Pain when the sides of the heel are squeezed
  • Tiredness

Severs Diagnoses

To diagnose the cause of the child’s heel pain and rule out other more serious conditions, the foot and ankle surgeon obtains a thorough medical history and asks questions about recent activities. The surgeon will also examine the child’s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.

Nonsurgical Treatments

The surgeon may select one or more of the following options to treat calcaneal apophysitis:

  • Reduce activity.  The child needs to reduce or stop any activity that causes pain.

 

  • Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel.

 

  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.

 

  • Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue.

 

  • Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile.

Often, heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.

Can Severs Be Prevented?

The chances of a child developing heel pain can be reduced by:

  • Avoiding obesity
  • Choosing well-constructed, supportive shoes that are appropriate for the child’s activity
  • Avoiding or limiting wearing of cleated athletic shoes
  • Avoiding activity beyond a child’s ability.

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