Sever's disease is a common condition causing heel pain that occurs because of overuse or repetitive stress activities. Learn more about this condition and how it is treated.
Key points
Sever's disease is a common condition that occurs because of overuse or repetitive stress activities that cause heel pain at the growth plate.
It gets better on its own with proper symptom management to reduce pain and inflammation.
Sever's typically occurs during growth spurts in those born female from 8 to 13 years of age and in those born male from 10 to 15 years of age.
Introduction
What is Sever's disease?
Sever's disease is a common cause of heel pain in children and teens. Repetitive stress activities that involve running and jumping can cause the growth plate on the heel bone to become inflamed and painful. Sever's disease is most seen during growth spurts in those born female from 8 to 13 years of age and those born male from 10 to 15 years of age. The condition will heal on its own by managing symptoms with rest and activity modification, physiotherapy, pain management and heel cup support. Once the growth plate closes, symptoms do not recur.
Signs and Symptoms
What are the signs and symptoms of Sever's disease?
heel pain with high-impact activities such as running and jumping
pain or tenderness over the heel
tight Achilles tendon
Diagnosis
How is Sever's disease diagnosed?
A health-care provider will perform a physical exam of the patient's foot to diagnose Sever's disease. Your child may also have an X-ray of their foot. This will show increased density and fragmentation of the growth plate if your child has Sever's disease.
Treatment
How is Sever's disease treated?
If your child is experiencing symptoms from Sever's disease, treatment strategies may include:
stopping or modifying activities that cause pain
wearing a walking boot to immobilize the foot
a physiotherapy program that includes stretching of the Achilles tendon and strengthening the upward movement (dorsiflexion) of the foot at the ankle
pain medications such as ibuprofen (e.g., Advil) or naproxen (e.g., Aleve) to help to reduce the inflammation
application of ice to the heel to reduce inflammation
an over-the-counter heel gel cup that is inserted under the soles of your footwear to support the heel and the growth plate
proper athletic shoes
Most patients return to their normal sports and activities within a few months after the diagnosis.
Resolution occurs with appropriate symptom management and once the growth plate closes.
Helping your child
Helping your child with a home exercise program
If the patient has Sever's disease, a daily home exercise program can be very helpful. The goal is to stretch the calf muscles and strengthen the muscles on the front of the legs. This will help your child successfully walk with a heel-to-toe pattern with less pain.
If the patient's calf muscles are tight, or ankle motion is limited, your treating physiotherapist can show you stretches to do at home with them.
These exercises will be necessary and beneficial as long as the patient continues to have heel pain. The most important part of an exercise program is to remember to have fun and to encourage them to do their stretches regularly.
Calf stretches for children over 6 year of age
Have your child stand approximately two feet from a wall. Place both of their hands at shoulder height against the wall.
With their right knee straight, have them step towards the wall with the left foot. They should lean in until a stretch is felt in the back of the right calf. Make sure they keep the heel of the right foot on the ground.
Hold the stretch for 60 seconds.
Repeat the exercise 10 times on each affected leg, daily.
When to Seek Medical Attention
When should your child seek medical attention?
If symptoms are unrelenting, then further evaluation by your primary health-care provider can be done to rule out other other possible diagnoses including infection, cysts or stress fracture. Assessments should include lab tests and an X-ray. If the X-ray indicates Sever's disease, then the above conservative management should be started. As this condition gets better on its own over time, there is no need for referral to orthopaedic surgery.
At Sickkids
At SickKids
SickKids does not accept referrals for Sever's Disease as it is a self-limiting condition. No orthopaedic surgery consultation or treatment is required.
