Understanding and Managing Heel Pain in Children and Adolescents

Sever’s Disease: Causes, Effects, and Remedies

Sever’s disease (calcaneal apophysitis) is a common cause of heel pain in children and adolescents, typically occurring during growth spurts. It is an inflammation of the growth plate in the heel bone (calcaneus) and is often linked to physical activity. While it’s not a permanent condition, proper management is essential to alleviate pain and prevent recurrence.

Causes of Sever’s Disease "Heel pain in children"

1. Growth Spurts:

   • It occurs during periods of rapid growth (typically between ages 8 and 14), when the heel bone grows faster than the surrounding muscles and tendons, causing tightness and strain on the heel.

2. Overuse and Repetitive Stress:

   • Physical activities that involve running, jumping, or excessive heel impact (e.g., soccer, basketball, gymnastics) place stress on the growth plate.

3. Foot Structure and Biomechanics:

   • Children with flat feet, high arches, or tight Achilles tendons are more prone to Sever’s disease due to increased strain on the heel.

4. Poor Footwear:

   • Shoes without proper cushioning or support can exacerbate heel strain, especially during sports or high-impact activities.

5. Obesity:

   • Excess weight increases pressure on the heel, contributing to inflammation of the growth plate.

Effects of Sever’s Disease

1. Heel Pain:

   • Pain and tenderness are typically localized to the back or underside of the heel, especially after physical activity.

2. Swelling and Redness:

   • Mild swelling or redness around the heel may occur due to inflammation.

3. Stiffness or Limping:

   • Affected children may limp, walk on their toes, or avoid placing weight on the heel to reduce discomfort.

4. Bilateral Impact:

   • Sever’s disease often affects both heels, although one may be more painful than the other.

5. Impact on Activities:

   • Pain can limit participation in sports or physical activities, affecting the child’s overall activity level and enjoyment.

Remedies for Sever’s Disease

Non-Surgical Remedies

1. Rest and Activity Modification:

   • Limit activities that involve running, jumping, or prolonged standing to allow the heel to heal. Encourage low-impact activities like swimming or cycling.

2. Ice Therapy:

   • Apply ice to the heel for 15–20 minutes after activity to reduce inflammation and pain.

3. Stretching and Strengthening Exercises:

   • Calf and Achilles stretches: Help reduce tightness in the Achilles tendon and calf muscles, relieving strain on the heel.

   • Foot strengthening exercises: Improve overall foot mechanics and support.

4. Supportive Footwear:

   • Use shoes with good arch support, cushioning, and shock absorption. Avoid flat or unsupportive shoes like flip-flops.

5. Orthotic Foot Insoles:

   • Heel cups, pads, or custom orthotic foot insoles can provide additional cushioning and support to reduce pressure on the growth plate.

6. Pain Relief:

   • Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain and reduce inflammation.

7. Physical Therapy:

   • A physical therapist can create a tailored program of stretches, exercises, and treatments to address underlying issues and prevent recurrence.

Lifestyle Adjustments

• Encourage regular breaks during sports and activities.

• Maintain a healthy weight to reduce pressure on the heel.

Medical Intervention

In severe cases or when symptoms persist despite conservative treatment, medical intervention may be necessary:

1. Immobilization:

   • A walking boot or cast may be recommended to rest the heel and allow healing completely.

2. Podiatric Assessment:

   • A podiatrist can evaluate foot mechanics and recommend custom foot orthotics or additional treatments.

Prevention of Sever’s Disease

1. Proper Footwear:

   • Ensure children wear supportive, well-cushioned shoes, particularly during sports and high-impact activities.

2. Stretching Routines:

   • Regular stretching of the calves and Achilles tendons can improve flexibility and reduce strain on the heel.

3. Gradual Increase in Activity:

   • Avoid sudden increases in activity levels. Allow time for the body to adapt to new sports or training regimens.

4. Limit High-Impact Activities:

   • Encourage a balance between high-impact sports and low-impact activities to reduce repetitive strain on the heel.

Conclusion

Sever’s disease is a temporary but painful condition common in active, growing children. It’s primarily caused by growth spurts and repetitive stress on the heel but can be effectively managed with rest, proper footwear, stretching, and supportive treatments like orthotics. With the right approach, children can recover fully and return to their normal activities without long-term issues. If symptoms persist, consult a healthcare provider for a tailored treatment plan.