Heel Pain in Children (Sever’s Disease)

Heel pain in children is commonly known as Sever’s disease. This condition is also referred to as calcaneal apophysitis. It mainly occurs in physically active girls aged between 8 to 10 years and in boys between the age of 10 to 12 years. Generally characterized by a sharp pain at the back of the heel, Sever’s disease also causes a mild limping or swelling that disrupts daily movement; the pain is usually more intense after running and sports. Sometimes referred to as growing pain, this condition arises when children go through growth spurts. Sever’s Disease is not an actual disease and their are several ways to help relieve the pain associate with this very common biomechanical condition.

Signs and symptoms

You’ll notice a number of signs and symptoms in your child, affecting one or both heels:

  • pain at the back of the heel
  • more intense pain during or after running, jumping, sports activities
  • tenderness (sometimes mild swelling or redness) at the back of the heel
  • calf muscle tightness, especially when rising in the morning
  •  the child tends to walk on their toes

What causes Sever’s disease?

Sever’s disease results from the fact that in children the bones grow faster than surrounding muscles, tendons and ligaments. In the lower leg there are two bones: the tibia and the fibia. At the back of the lower leg the Achilles Tendons join the calf muscles to the heel. If the lower leg bones grow faster than the calf muscles, the Achilles Tendon is placed under stress and tightens up, leading to pain and inflammation.

In addition, in children it takes time for bones to become totally ossified (turned into bone). In this case the soft cartilage at the back of the heel bone has not yet ossified, making it a potential weak spot. The constant pulling of the Achilles tendon at the not yet ossified heel bone (or growth plate) causes a traction injury at this weak spot.

A major contributing cause to Sever’s Disease is over-pronation: rolling in of the ankle joint and flattening of the arches.

Other contributing factors include stiffness in the lower limbs and foot tendons, rapid foot growth, use of faulty (unsupportive) footwear along with repeated minor injuries to the rear of the heel. At times, bone spur overgrowth with small fractures can be noticed in this part caused due to tension as well as injury to the heel bone.

Prolonged suffering from Sever’s disease makes many children vulnerable to several other ailments like knee problems or Osgood Schaltter’s disease, hip disorders called iliac apophysitis or elbow disorders like little leaguer’s elbow. These children are unable to tolerate the strain and stress of any physical activities or exercise. The joint between the growing part of the heel and the rest of the bone becomes extremely weak and therefore prone to breakage.

Prevention and treatment of children’s heel pain

Although Sever’s Disease heals itself with time it can be quite debilitating for the child with extended periods of suffering. Therefore it is worth looking into some of the treatment options available nowadays.

  • to keep the feet and legs muscles flexible and supple, regular stretching exercises are beneficial
  • jumping or running on hard surfaces must be avoided, exercise & sports should be limited
  • properly fitted shoes with plenty of support and rearfoot stability are recommended
  • whenever pain occurs, apply ice packs for about 10 minutes to help reduce the inflammation
  • orthotic innersoles should be opted for to control over-pronation, which is very common in children. The device will support and balance to the foot, allowing it to function more naturally, reducing the excess strain on the Achilles.
  • to prevent any mechanical abnormalities in the lower limb function, foot strapping can be used as a temporary measure

Recommended orthotics for children’s heel pain:

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