Sever’s disease, also known as calcaneal apophysitis, is the most common cause of pediatric heel pain.1 The “calcaneus” is the heel bone and an “apophysis” is a growth plate. Thus, you might have guessed that “calcaneal apophysitis” means inflammation of the growth plate of the heel. Calcaneal apophysitis was named for Sever who was one of the first to describe the condition in 1912.1 Sever’s disease can cause heel pain, mild swelling, and difficulty walking in children and young adolescents. Since we are specialists in young female athletes, heel pain is a condition we treat often at Girl Fit.
Sever’s disease (calcaneal apophysitis) is thought to be related to repetitive pulling of the Achilles tendon and calf on the growth plate of the heel.2 This is a similar proposed mechanism of injury to that of Osgood-Schlatter syndrome and Sinding-Larsen-Johansson (SLJ) syndrome at the knee. Children and young adolescents are impacted by these traction forces because of their open growth plates, resulting in heel pain.2 Factors which may contribute to this heel pain are flexibility of the calves, strength of leg and core muscles, lower extremity mechanics, and deviations in foot posture, such as increased pronation.3
Like any overuse injury, the first step is to decrease activities which cause heel pain. These painful activities may include running, jumping, and hopping. As sports medicine specialists, we understand how much sports mean to our patients. We will work with each individual patient to adjust painful activities to allow for safe participation in some aspects of their sport when possible. Modifying the more stressful activities will allow time for the heel pain to subside and to make progress with physical therapy.
Physical therapy treatment may include:
Though heel pain and Sever’s disease are common, we treat each of our patients as individuals. We will create a unique plan of care based on a physical therapy evaluation. We pride ourselves in our patient education and empowering our patients to understand their physical therapy plan, no matter their age!
To schedule a physical therapy evaluation, email us at firstname.lastname@example.org or give us a call at 617-618-9290. If your child is not injured but is experiencing a growth spurt and/or planning to increase their participation in sports, you can schedule a wellness visit to get an individualized injury prevention program. Physical therapy and wellness visits are being offered both in person and virtually. We can’t wait to help your child run, jump, or hop back onto the field pain free!
Kate Hamilton, PT, DPT
Orthopedic Clinical Specialist
Follow us @girlfitrocks
1 Yakel J. Sever’s Disease (Calcaneal Apophysitis). Podiatry Management. 2012;31(6):163-166.
2 Granado M, Dressendorfer R. Sever’s Disease. Richman S, ed. CINAHL Rehabilitation Guide. June 2018.
3 Scharfbillig RW, Jones S, Scutter S: Sever’s disease: a prospective study of risk factore. JAPMA 101 (2): 133-145, 2011.
3 Perhamre S, Lundin F, Klässbo M, Norlin R. A heel cup improves the function of the heel pad in Sever’s injury: effects on heel pad thickness, peak pressure and pain. Scandinavian journal of medicine & science in sports. 2012;22(4):516-522.
4 Perhamre S, Lundin F, Norlin R, Klässbo M. Sever’s injury: Treat it with a heel cup: a randomized, crossover study with two insole alternatives. Scand J Med Sci Sports. 2011;21(6):e42-e47.
5 Perhamre S, Janson S, Norlin R, Klässbo M. Sever’s injury: treatment with insoles provides effective pain relief. Scand J Med Sci Sports. 2011;21(6):819-823.