Heel Pain in Growing Children: An In-Depth Look at Severs Disease
As a parent of an active child, aches and pains associated with regular activity and growth are a frequent complaint, with heel pain often a recurring theme. This can arise from a range of daily activities such as family hikes, long walks, or high-impact movements like running and jumping. The worrying part for any parent is not knowing when this discomfort is no longer just “growing pains” but has progressed into a specific condition known as Sever's Disease.
It can be challenging to navigate these moments effectively as a parent. That’s why it’s essential to recognise and understand what symptoms should not be ignored, and what treatments are recommended to support recovery. This comprehensive guide explores how to manage, treat, and recover from heel pain in active children, with a particular focus on Sever's Disease.
Unpacking Sever's Disease
In medical terms, Sever’s Disease is correctly known as Calcaneal Traction Apophysitis. This name refers to inflammation occurring at the growth plate (apophysis) of the heel bone (calcaneus), where the Achilles tendon and plantar fascia attach. This inflammation can cause significant pain and discomfort, often limiting a child’s ability to walk, run, or participate in their favourite sports or activities. At its peak, Sever’s Disease can lead to pain that occurs all day and even first thing in the morning or after long periods of rest.
This condition is most commonly diagnosed in children aged between 8 and 14, particularly those involved in high-impact sports such as netball, soccer, rugby, gymnastics, and basketball. These activities place considerable stress on the heels, which can lead to irritation and inflammation of the growth plate. Typically, symptoms emerge 2–6 weeks after a sudden increase or change in activity levels. However, it’s not just sport that contributes—children who spend considerable time on hard surfaces like concrete, or who have recently gone through a growth spurt, are also at greater risk of developing Sever’s Disease.
The Development of Sever's Disease: A Closer Look
Sever's Disease typically occurs when your child's growth plate, which is softer and less developed than adult bone, becomes irritated by the pulling force of the plantar fascia and/or Achilles tendon. This tension can lead to premature bone remodelling, weakening the bone’s ability to manage ongoing stress and pressure.
Growth spurts can also be a contributing factor, but it’s important to differentiate between typical “growing pains” and Sever’s Disease, which is a medical condition requiring timely intervention. Left untreated, Sever’s Disease can lead to significant pain, altered bone development, and even microfractures.
While it may be challenging to prevent the onset of Sever's Disease entirely, there are proactive measures parents can take to minimise its progression. These steps include encouraging periods of rest, discouraging overuse of the affected area, and exploring therapeutic interventions like custom orthotics or the use of bracing like the Severs Sleeve to reduce tension and load pressure on the growth plate.
Spotting the Symptoms of Sever's Disease
There are several signs parents should watch out for:
- Persistent or recurring heel pain during and after physical activity, continuing into the evening or the following day
- Changes in gait (walking pattern), including limping, toe-walking, or an early heel lift
- Pain localised to the back or underside of the heel, which may intensify upon walking
- Visible signs of inflammation such as swelling, redness, or tenderness at the heel
If these symptoms persist for more than two weeks, Sever’s Disease a healthcare professional should be consulted promptly. If left untreated, Sever's Disease can be debilitating and impact your child's growth and quality of life.
Treating and Rehabilitating Sever's Disease: A Multi-Pronged Approach
Effective management, treatment, and rehabilitation of Sever's Disease is fundamental to ensuring a safe and full recovery for your child.
Initial treatment typically involves a period of rest and activity reduction to offload the heel and minimise aggravation. However, rest alone is not a comprehensive treatment for Sever's Disease. Short bouts of complete rest followed by an abrupt return to exercise will likely result in the recurrence of Sever's Disease.
Crutches, taping strategies, heel lifts and custom orthotics can be beneficial as they offer a mechanical way to rest and offload the growth plate, lessening the inflammatory process. Incorporating manual therapy (such as massage and dry needling), along with progressive strength exercises targeting the Achilles tendon, is crucial for an expedited recovery.
The introduction of the Severs Sleeve brace, which consistently offloads the growth plate while encouraging normal walking, allows earlier restoration of function and contributes to a quicker recovery.
Monitoring your child's transition back to progressive exercise is equally important to avoid reaggravation or exacerbation of the condition. Objective testing can help determine when it's safe for your child to return to sports and activities and should be done under the guidance of a healthcare professional.
The Role of Braces in Treating Sever's Disease
The Severs Sleeve is a highly effective device that should be introduced gradually. Begin with 1-2 hours on the first day, increasing by an hour per day.
This brace works by offloading the growth plate, reducing pain, and promoting normal movement and recovery. It achieves this via its patented design reducing the tension of the Achilles tendon and plantar fascia on the growth plate. As with any treatment, always consult with a healthcare professional to ensure that the Severs Sleeve is used appropriately as part of a comprehensive recovery plan.
Overcoming Sever’s Disease requires a clear understanding of the condition, patience, and the right approach to treatment. With the guidance provided in this comprehensive blog, we hope to equip parents with the knowledge and tools necessary to support their child through this challenging period. For more personalised assistance or to schedule a private consultation, feel free to reach out to our team at any time.
From Pain to Performance
The Orthopaedic Sleeve Society (TOSS)