Heel pain can also occur in children, most commonly between ages 8 and 15, as they become increasingly active in sports activity in and out of school. This physical activity, particularly jumping,
inflames the growth centers of the heels, also known as the apopyhsis. The more active the child, the more likely the condition will occur. Your doctor may also describe the condition as Sever's
Disease or calcaneal apophysitis.
Sever?s disease is an osteochondrosis caused by overloading the insertion of the Achilles tendon onto the calcaneus and the apophyseal growth plate in this area. This C-shaped growth zone can become
inflamed secondary to repetitive traction stress of the Achilles tendon. Calcaneal apophysitis is a common injury in young athletes and is believed to be caused by running and jumping. Active
Children and adolescents (usual age of occurrence 7 to 15 years), particularly during the pubertal growth spurt or at the beginning of a sport season (e.g. gymnasts, basketball and football players),
often suffer from this condition. This disease occurs most commonly during the early part of the growth spurt. A boy-to-girl ratio is 2-3:1. None of these causative factors has been tested
prospectively and, where tested, none of the measurements has been carried out systematically, and reliability or validity of the measurements has not been considered.
In Sever?s disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or
she stands on tiptoe. Your child?s heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your provider may also find that your child?s heel tendons have
Low-grade inflammation of the calcaneal apophysis cannot be seen on x-ray. Therefore, although x-rays are often done to rule out bony injuries in children with Sever's disease these x-rays are
usually normal. Advanced Sever's disease can be seen on x-ray but usually the problem is treated before it reaches this point. Other diagnostic tests, such as bone scans or MRI's, are not usually
required in typical cases of Sever's disease. These, or other tests, may be required to rule out other conditions, such as stress fractures of the calcaneus or other bony abnormalities that can mimic
Non Surgical Treatment
Orthotics, The orthotics prescribed are made to align the foot in its correct foot posture. This will reduce stress and force at the site of the growth plate of the heel bone. Rest and Ice the heel
20 minutes before and after sporting activity. Calf muscle stretching exercises.
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