Doctors’ Notes


Heel Pain

I previously reviewed an apophysitis, or growth plate inflammation, at the knee commonly called Osgood Schlatter Disease. In this Note, I’ll will discuss another apophysisits — this time at the ankle.

What is Sever’s Disease?

Sever’s Disease, or Calcaneal Apophysitis, is another common growth plate injury found in the pediatric population. Sever’s Disease is believed to be the byproduct of repepitive stress and trauma to the growth plate in the calcaneous, or heel bone. The stress is from the pull of the Achilles tendon on the growth plate where the tendon attaches.

Who Gets It?

This condition is more common in boys than girls. It generally presents between the ages of 9-14 and peaks between ages 10-12 years. This injury can reoccur up until the age of 17, when the growth plate of the calcaneous generally closes. These types of injuries will commonly occur during periods of rapid  growth. Sever’s Disease occurs more frequently in child with flat feet, but all children with flat feet will not get Sever’s.

How DO I Know if My Child Has Sever’s Disease?

Roughly 60% of the time this condition affects both ankles and presents as a diffuse, achy pain and a swelling of the heel that increases with exercise and improves with rest.

How Does it Get Better?

Treatment is primarily supportive, with rest, pain management, and activity modification. Activity modifications include the addition of low-impact activities. Gel heel cups are sold over the counter and can be used intermittently to help reduce shock in the heel, as well as take tension off of the tight Achilles’s tendon complex. Proper stretching and strengthening activities should be preformed routinely even during periods of no pain. A large study showed that approximately 85% of children affected by Sever’s disease return to full activity within a two-month time period after starting treatment.

When Should I Be Concerned?

  • If left untreated, even a very mild case of Sever’s Disease can cause limitation in even daily activity. If there is any limitation in normal daily activities, that pain should be evaluated.
  • Pain in a heel or ankle associated with a known injury should be evaluated, as other injuries to the growth plates like fractures could be present.
  • If you have questions or concerns at any time about any injury or pain and its severity, please call the office to discuss with one of our Kids Plus team members.

Travis Lewis, a Kids Plus Provider, is a certified Athletic Trainer and a certified Physician Assistant.