Severs Disease – Heel Pain In Children
David Kingston
B.Sc. (Hons) Orthotics MIAPO
Last Updated: November 7,2021
What Is Severs Disease?
Severs Disease is a chronic pain in the heel that effects children that are particularly active in their early teen and pre-teen years.
There is nothing worse as a parent than watching your child in pain. What can be doubly upsetting is when that pain is associated with an otherwise healthy activity such as sport or dance. These kind of activities are important for development as well as for general health so it is concerning when children cannot do them due to pain.
Also, because the pain means the children may have to stop doing what they love - sport and dance - they will be less happy.
One such painful condition is commonly referred to as 'Severs Disease'. The more medical sounding name of Severs is calcaneal apophyitis. It is basically a swelling (inflammation) of the heel bone where it attaches to the Achilles tendon.
Severs Disease Overview
- A heel pain caused by prolonged stress on on the Achilles Tendon and heel bone during high level activity and weight-bearing activities.
- Pain occurs due to the stress on the growth plate in the heel bone.
- The stress applied to the heel bone when it is in a bad position causes a throbbing-like pain especially post exercise.
- Orthotics for their feet can achieve this necessary healing for pain relief.
Is It Really A Disease?
Due to its common name it can seem a scary name that really isn't what we would class as a disease in today’s terms but was named after a doctor Severs way back when everything that hurt was given a name and usually labelled as a disease.
It's not, it's an orthopaedic condition that develops in active children in their heels particularly after high intensity activities like sport training sessions or dance classes.
It is a condition associated with children rather than adults as it's associated with the growth stage of puberty and sometimes pre-puberty.
It is most commonly seen in girls from ages 8 to 14 and boys from 9 to 15.
These ranges are not set in stone as we do see kids that develop this outside these age groups but it's less common.
The reason for Severs to commonly present in this age range is because this is when children's skeletons start to grow rapidly and in the heel bone there is a growth plate, called an epiphyseal plate.
This area is at the top part of the heel bone where the cells that are cartilage start to harden and become bone cells.
This can continue to happen for a few years through the growth phase but eventually the heel becomes all bone and the growth plate disappears completely.
This is how all our bones grow bigger when we are young but the heel bone growth plate is special in that it is very close to a tendon that 'pulls' on the heel bone aggressively.
It is this combination of the growth plate doing its thing and the pull force of the calf muscle on the heel bone through the Achilles tendon (heel cord) that leads to pain the child experiences.
This is why we very rarely see Severs Disease in a child of 15 or over. It can happen but is usually in late developers.
The Signs and Symptoms Of Severs Disease
Well, the most obvious sign of Severs is of course pain. Pain in the heel particularly after high intensity exercise that can last into the night and may not subside until the morning.
Other related symptoms include:
- A difficulty in walking especially barefoot
- Stiffness in the feet in the morning after exercise
- Selling around the heel
- Pain on squeezing of the heel bone
So How Does This Cause The Aggressive Pain?
Well, the calf muscle, the Achilles tendon and the heel bone work in tandem to do things like stand, walk, run and jump. Seems obvious, I know, but what most people do not realize is the size and magnitude of the force that is applied through these structures to achieve these movements.
The pull of the calf muscle on the heel bone is massive. Even in adults they can acquire conditions of this area such as Achilles Tendonitis through even moderate exercise.
However, in children as the growth plate develops the force can cause debilitating pain in the heel if certain factors are present.
What Causes Severs To Occur?
In short, Severs Disease is a mechanical condition. If the heel bone is ‘rolled-in’ position when the child is standing, walking or running then the stress applied to the heel chord and it’s pull on the heel bone ‘causes’ Severs.
This can come from ankle pronation – a rolling in of the ankle that creates an appearance of a low or flat arch.
Less common is a very high arch that cause the ankle to ‘roll’ to the outside on weight bearing and have the same (but visibly opposite) effect on the heel bone.
Sometimes when a child is overweight it can be a suggested cause of Severs but this is not correct but it does not help the situation.
Rarely Severs Disease can be caused by the foot and ankle trying to ‘correct’ for a leg length difference.
How Is Severs Diagnosed and Treated?
Usually a correct physical examination of the anatomy and biomechanics is enough to identify if a child has Severs or something else that might seem like Severs like a stress fracture.
Severs does not present in X-Rays or MRI scans so these are fruitless for a diagnosis.
Treatment is focused on relieving pain by ‘realigning’ the ankle position.
This is done using specially design custom foot orthotics with particular design elements aiming to alter the application of the heel chord forces on the heel bone. This will allow the growth plate to ‘accept’ these forces without becoming inflamed.
With the correct alignment many children become pain free and can take part in sport again within a very short time frame but this will vary from child to child.
Can We Help Your Child's Heel & Foot Pain?
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There is no obligation to continue with orthotic treatment and if we feel you child needs some other type of treatment we can refer you to the appropriate person.
David Kingston
B.Sc. (Hons) MIAPO