Calcaneal Apophysitis (Sever's Disease): causes, symptoms and treatments

What causes calcaneal apophysitis?

The Achilles tendon pulled tight by the tension exerted from the growth of the heel, can damage the growth plate. A growth plate is the cartilaginous part of the end of a growing bone. Over time, the cartilage cells transform into hardened bone cells, forming a fully-mature length of the bone.

But when the child has sever's disease, they suffer from inflammation, swelling, and pain in the heel. Repetitive stress of physical activity exacerbates the pain, which is why Sever’s disease is the most common cause of heel pain in young athletes.

Symptoms of calcaneal apophysitis

Symptoms can manifest in both heels or in just one. Some common signs and symptoms include:

• Pain, swelling, redness, and tenderness in the back of the heel

• Redness, and tenderness in the back of the heel

• Pain in the sides or bottom of the heel
• Pain that is exacerbated by activity then subsides with rest
• Discomfort and stiffness while walking
• Limping or tiptoeing to avoid heel pain
• Pain when squeezing the sides of the heel between two fingers
• Difficulty running

Risk factors for calcaneal apophysitis

Calcaneal apophysitis can affect any child, but some children are at an increased risk. They include kids who: 

Are physically active

Sever’s is fairly common among young gymnasts, runners, soccer players, and basketball players. Children who spend a lot of time running and jumping, especially on hard surfaces, are much more susceptible because their activities repeatedly strain the already-overstretched and tight Achilles tendon. The tendon pulls on the heel, irritating the cartilaginous growth plate

Wear cleats or improper shoes 

Cleats center the force of running’s impact on the heel. If your child has flatfeet or other arch abnormalities, cleats can also exacerbate the condition.

Wearing ill-fitting shoes or shoes that rub on the back of the heel can lead to calcaneal apophysitis.

Have Flat feet or high arches

Both flat and high arches can affect the foot’s mechanics and the way the Achilles tendon pulls on the heel.

Have Pronation

Pronation is a term used to describe the inward rotation of the ankle while walking. While some pronation is typical, over-pronation can cause tightness in the Achilles tendon.

Have short-leg syndrome

If one of your child’s legs is shorter than the other, the heel of the shorter leg has to work harder to hit the ground. This can cause strain on the Achilles tendon, which pulls harder on the growth plate of that foot.

Carry extra weight

Children who are overweight or obese may be at an increased risk because their weight can put excessive pressure on the growing heel.

Diagnosing Sever's disease

When it comes to diagnosing sports-related heel pain in children, the first thing we do is conduct a complete medical history and physical exam. Most of the time, there’s no need for an X-ray.

From the outside, the foot will appear normal, with no redness or swelling.  We can make a diagnosis using a simple squeeze test, right here in the clinic.

Treating calcaneal apophysitis

If your child is experiencing pain or having difficulty walking, please make an appointment with us. Your foot and ankle specialist will examine your child’s feet, obtain a thorough medical history, and ask about recent activities. The doctor may squeeze your child’s heel from both sides or have your child stand on tiptoes to check for sources of pain. X-rays, advanced imaging studies, or other laboratory tests may be ordered to rule out any other possible problems, such as an acute injury.

Though there are several ways to treat the symptoms of Sever’s disease, the only “cure” for the condition is to outgrow it. It may take up to two years for your child to complete his or her growth spurt. In the meantime, your child can manage the pain by:

Resting

Your pediatric foot and ankle specialist will likely recommend cutting back on physical activities that involve running and jumping. Your child may be able to stay active by swimming, cycling, rollerblading, or playing sports that put less strain on the Achilles.

Stretching the leg muscles

Your foot and ankle specialist can demonstrate a few exercises that can help stretch and strengthen the Achilles.

Wearing elastic wraps or compression socks

These can reduce discomfort and swelling in the heels. Ask your foot and ankle specialist for brand recommendations.

Wearing appropriate shoes

Wear athletic shoes appropriate to your child's activity 

Icing and elevation

Wrap an ice pack in a cloth and apply it to the heel for 15 minutes, three times per day. You should do this even on days when your child doesn’t complain of pain. Icing combined with elevation can cut down on swelling.

Taking oral medication

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can reduce pain and inflammation.

Orthotic inserts

These are custom-fitted padded shoe inserts that alleviate pressure from the heel, distributing it over a larger area of the foot. This can relieve the strain on your child’s heel, reducing pain and giving your child’s foot a better chance to heal. Additionally, heel cups can protect the heel and provide padding and shock absorption.

Physical therapy

Physical therapy techniques can decrease inflammation.

Immobilization

If your child’s case is very severe, your UFAI specialist may put the ankle in a boot or cast to immobilize the foot and allow the growth plate to heal.

Recovering from Sever's disease

With rest and proper treatment, most cases of Sever’s disease will improve within 2-8 weeks. Although your child may be reluctant to stop playing his or her favorite sports, it’s important to get rest and treat the symptoms sooner rather than later. The sooner you seek treatment, the quicker the recovery. Fortunately, there are no lasting negative effects for your child as he or she grows into young adulthood.

Calcaneal apophysitis may return if steps are not taken to support the heel and protect the growth plate from stress. Make sure your child is wearing supportive, well-fitted shoes with shock-absorbing soles to cushion the heel from repeated impact. For casual, everyday wear, we recommend buying your child's shoes without backs, such as sandals or clogs, so that the heel has room to expand and move.

Heel pads, heel lifts, and/or arch supports are a good idea for long-term foot health. Check in with your foot and ankle specialist about the right orthotics for your child.

Why UFAI is the right choice for pediatric foot and ankle conditions.

University Foot and Ankle Institute's physicians have been successfully treating pediatric patients for over 20 years. They pride themselves in offering the very best care in a relaxed, compassionate, and patient environment.