Though heel pain is not unusual in adults, it is fairly rare in kids. By far, the most common cause of heel pain in children is a disturbance to the area at the back of the still-growing heel bone. While some children are more prone to it than others, undue stress or overuse of the foot, especially sports that take place on hard surfaces, is considered to be the most frequent cause of pain in the heel.

A growth plate is an area that sits at the end of a developing bone. In these areas, cartilage cells slowly transform into bone cells, and the growth plates expand and come together as the bones mature and develop. With the heel bone, one large developmental area starts in the middle of the heel cartilage and gradually spreads outward. This area eventually fuses with another developmental area at the back of the heel bone to become a single bony mass. Damage or disturbance at the point where these areas unite can cause what is known as Sever’s disease.

About Sever’s Disease

Sever's disease (also called calcaneal apophysitis) is a painful bone disorder that develops as a result of inflammation or swelling of the growth plate in the heel. During the growth spurt that occurs in early puberty, the heel bone sometimes grows faster than the leg muscles and tendons. This incongruous growth causes the muscles and tendons to become unusually tight. Because the heel area is less flexible, the tight heel tendons may put too much pressure on the growth plate during weight-bearing activities.

The Achilles tendon is the strongest tendon that attaches to the growth plate in the heel. Repeated stress on an already tight Achilles tendon can damage the growth plate over a period of time. This can lead to the swelling, tenderness, and pain near the heel that is the main characteristic of Sever's disease.

The condition most frequently occurs in physically active girls and boys between the ages of 8 to 10 and 10 to 12, respectively. In other words, the child is at the most risk of Sever’s disease during the growth spurt in early puberty. The back of the heel typically finishes growing by age 15, so the condition is not common among older teenagers.

Children who play soccer, participate in gymnastics, or do any running or jumping activity are at an increased risk of developing Sever’s disease. Other risk factors include being overweight, having a tight calf muscle, or being afflicted with a pronated foot (where the foot rolls in at the ankle during walking). Poor-fitting shoes often contribute to the condition by not providing enough support or padding for the feet or by rubbing against the back of the heel.

Heel pain and tenderness in one or both heels are the most obvious signs of Sever’s disease. There may also be swelling and redness in the heel and the child may have difficulty walking. The child may try to compensate for the pain by limping or tiptoeing. He or she may feel an increase in pain while running or jumping. In fact, these symptoms usually worsen during or right after physical activity, but then abate as the child rests.

A doctor might be able to diagnose the condition based solely on the child’s symptoms. The physician may ask about details regarding the child’s participation in sports or other physical activity. During a physical examination, the child may experience pain while standing on tiptoes or when the back part of the heel is squeezed from both sides at the same time. There may also be a reduction in the range of ankle motion as well as tightening of the heel tendons. Imaging tests such as X-ray scans may be ordered to rule out other conditions (such as fractures) that may cause similar pain.

The immediate goal of treatment is pain relief, so over-the-counter medicines such as acetaminophen or ibuprofen may be recommended. The patient should also reduce or eliminate any activity that causes heel pain. Parents should also apply ice wrapped in a wet towel to the injured heel for about 15 to 20 minutes three times a day. Also, the use of an elastic wrap or compression stocking can help decrease pain and swelling in the heel.

During treatment, the child should never be allowed to go barefoot. The doctor may even recommend the use of orthotics, arch supports, or heel cups in children who have a high foot arch, flat legs, or bowed legs. In severe cases, the child may have to wear a cast for anywhere from 2 to 12 weeks in order to immobilize the foot and ensure faster healing.

Fortunately, few long-term problems are linked to Sever’s disease. With proper care, the condition usually goes away within 2 to 8 weeks and does not cause any problems later in life. If there is no improvement in the heel pain, or if the pain worsens or the heel changes color or swells, the child may have to return to the doctor’s office for a change in the treatment regimen. Generally speaking, the earlier the disease is addressed, the quicker the recovery will be. Once the heel pain is gone, the child can return to physical activity again.

Role of Stretching Exercises

Sever’s disease sufferers can facilitate the healing process by doing exercises that stretch the hamstring, calf muscles, the muscles on the front of the shin, and the tendons on the back of the leg. It is important for the child to stretch both legs even if the pain is in one heel. The stretching exercises should be performed at least three times a day, and each stretch should be held for a period of 15 to 20 seconds. The doctor may send the child home with instructions on how to complete the necessary exercises, or a physical therapist can assist the child in stretching properly.

It is wise to take measures to prevent a recurrence of Sever’s disease after the child returns to physical activity. Maintaining good flexibility will help prevent the condition from coming back, so encouraging the child to do stretching exercises can increase muscle elasticity, especially after physical activity. The child should also be wearing high-quality, shoes that fit well and are designed for his or her specific sport. If the child frequently runs on hard surfaces, footwear with shock absorbent padded soles may help reduce pressure on the heel. Heel pads, heel lifts, or heel arch supports can help if the child has a pronated foot or an arch that is flat or high. Recurrence of the condition can also be prevented by applying ice to the heel after physical activity. If the child is overweight or obese, weight loss may be necessary to decrease pressure on the heel.

Sever’s disease can cause pain and discomfort and force children to stop playing the games and sports they love. But with the proper treatment, the condition will disappear without leaving any lasting side effects. By encouraging kids to adopt smart athletic habits, wear proper shoes, and take preventive measures to avoid recurrence, parents can help their children enjoy physical activity that is fun and pain-free.