What is Sever’s Disease? (Calcaneal Apophysitis)

Sever’s disease, also known as calcaneal apophysitis, is a painful inflammation of the growth plate in the heel. Though it is not an actual disease, it is one of the most common causes of heel pain in children between the ages of 9 and 12 years old.

Growth plates are composed of cartilage and located near the ends of bones like the calcaneus, or the heel bone. Until an adolescent reaches the age of maturity, these growth plates are weaker than the surrounding tendons and ligaments, leaving them more susceptible to trauma.

Inflammation of the calcaneus’s growth plate (physis) is a result of repeated stress to the heel. It can also occur from frequent pulling of the Achilles tendon, a tough band of tissue connecting the calf muscle to the heel bone. The physis at the bottom of the heel is an attachment point for this tendon.

Sever’s disease is typically treated symptomatically. This article provides information about Sever’s disease in children along with how PowerStep® insoles for kids can prevent and relieve pain so your child feels more comfortable doing the activities they love.

Sever’s Disease in Children

The inflammation that characterizes Sever’s disease in kids typically occurs during growth spurts like puberty. This is when bones, muscles, tendons, and other structures in your kid’s body are rapidly changing. Although common in highly active children, the condition may also affect kids who are less active or overweight. Kids who wear flat shoes that lack arch support are also at risk.

Because this condition particularly affects children who are still growing, Sever’s disease in adults does not exist. Once the body reaches maturity, solid bone replaces the physis. Adults experiencing heel pain likely have a different condition such as Achilles tendonitis or heel spurs.

Symptoms of Sever’s Disease

Activities involving running or jumping, like track and field sports, gymnastics, or soccer, can put stress on kids’ feet. These activities may cause excessive pulling on the Achilles tendon, which attaches to the back of the inflamed heel bone. This results in symptoms like minor swelling of the back of the heel, tenderness, and pain.

The symptoms of Sever’s disease may be similar to plantar fasciitis or shin splints. It worsens with activity and sometimes the pain may extend to all around the heel. Common symptoms include:

• Swelling and redness
• Limping when walking
• Walking on toes
• Difficulty running, jumping, or participating in usual activities or sports
• Overpronation in toddlers
• Pain when the sides of the heel are squeezed
• Tiredness

Diagnosis

If your child has any of the above symptoms or complains about pain in their heel when they walk or play sports, it’s worth a trip to your pediatrician. During the appointment, the doctor may ask questions regarding your child’s symptoms, health, and activity level.

Then they conduct a physical examination, applying pressure around the foot and ankle to determine what is causing the pain. Children with Sever’s disease find these areas to be tender and painful. The doctor may ask your kid to run, jump, or walk on their heels to see if it causes more pain. Some pediatricians may suggest an X-ray to rule out other possibilities, such as bone fractures.

How is Sever’s Disease Treated?

Because it is not a permanent condition, Sever’s disease treatment focuses on reducing pain and swelling through a combination of rest, icing, medications, and insoles or footwear that lessen the tension on the Achilles tendon. Some ways you can help manage your child’s pain are:

• Icing the area of inflammation
• Limiting daily exercise until your child can enjoy activities without discomfort
• Over-the-counter pain relievers or child-safe pain relief gels or creams
• Inserting heel cups, pads, or cushions into their shoes to absorb shock and relieve stress on the heel and ankle
• Wearing shoes with slightly elevated heels to reduce pressure on the growth plate
• Stretching of the calf muscles once the pain has subsided to strengthen the tendons
• Using kids orthotics that feature arch support and cushioning

Managing Sever’s disease may take up to several months. If the pain is not too severe, your child may be able to return to their sports activities by wearing Sever’s disease heel cups or cushioned insoles for kids.

Prevention Tips

Keeping your child healthy and out of pain so they can be happy doing the activities they love is one of the primary goals of a parent. Luckily, there are several steps you can take to prevent Sever’s disease from occurring, such as:

• Helping them maintain a healthy weight
• Choosing supportive and cushioned shoes that are appropriate for their activity
• Limiting how often they wear cleated athletic shoes or shoes that are flat
• Avoiding activity beyond a child’s ability
• Varying the type of sports they do with low-impact options like swimming or bike riding

"PowerStep® Pinnacle Junior orthotics prevent and relieve foot pain while also alleviating ankle and knee pain."

Preventing Sever’s Disease with Kids Shoe Insoles

PowerStep offers a few options for insoles for kids that help relieve and prevent pain associated with Sever’s disease. Children wearing adult sized shoes can wear performance insoles for running and other sports to support the arch of their foot and reduce or prevent heel pain.

Our Pinnacle Junior insoles are full length insoles for toddlers and kids in youth size shoes. Designed to cradle the arch and the heel, our kids shoe insoles provide the perfect balance of comfort and support, limiting stress on the feet, ankles, joints, and tendons.

Like Sever’s disease, growing children are also prone to developing flat feet which can cause other foot conditions later in life. To prevent overpronation in toddlers and kids, our Pinnacle Junior ¾ insoles have an elevated heel post and deep heel cradle for increased protection from heel pain. The ¾ length fits athletic shoes, too, giving them the support they need so they can keep playing pain-free.

PowerStep Orthotics & Insoles for Kids

Both adults and children experience heel pain. PowerStep orthotics come in a variety of sizes and designs to suit everyone’s needs. As the number one podiatrist recommended brand, PowerStep Pinnacle Junior orthotics easily fit toddler’s and kid’s feet. They provide the same quality arch support and dual-layer cushioning as adult sizes.

Your child shouldn’t have to miss out on any kind of play whether they’re in the backyard with their friends or out on the field for a game of little league. Make sure your little one has everything they need to stay healthy, active, and pain-free by taking the right steps to prevent heel pain.

References:

Smith, J. M., & Varacallo, M. (2019, May 6). Sever’s Disease. Nih.gov; StatPearls Publishing.   

Sever’s Disease (Heel Pain) - OrthoInfo - AAOS. (2012). Aaos.org.

Sever’s Disease (Calcaneal Apophysitis): What Is It, Symptoms & Treatment. (n.d.). Cleveland Clinic.

Sever’s Disease | Boston Children’s Hospital. (n.d.). www.childrenshospital.org.