Sever's Disease

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Sever's Disease

Sever’s disease is a painful condition of the heel that occurs in growing children. It happens when the tendon that attaches to the back of the heel (the Achilles tendon) pulls on the growth plate (the apophysis) of the bone of the heel (the calcaneus). The repeated stress on the growth plate causes pain and inflammation at that site.

It most commonly occurs in physically active children between the ages of 8 and 14 years of age. This pain is often worsened by physical activity or when Achilles tendons are tight.

Pain can also be worse during a “growth spurt,” when the bones grow faster than the tendons. This increases the pull of the tendon on the heel.

While painful, Sever’s disease is not a serious condition. It will not cause long term damage or arthritis and often resolves once the growth plates close.

Signs and Symptoms

  • Heel pain in one or both heels, which often comes and goes
  • Pain that gets worse with activities, especially with new or strenuous activities
  • Pain may cause limping or walking on toes to avoid putting pressure on the heels
  • Pain that is worsened by running or jumping
  • Pain with pressing on the back of the heel
  • Pain is worse upon waking

Treatment

Rest: Limit physical activities, especially running and jumping, while having pain. Take rest breaks between activities.

Ice: Ice the heel for 15 to 20 minutes when having pain or after activities. Do not place ice directly on skin. Put a towel or other cloth between the ice and the skin.

Pain Relief: Anti-inflammatory medicines, such as ibuprofen (Motrin® or Advil®) or naproxen (Aleve®) can be used as needed for pain and inflammation (swelling). Always give your child these medicines with food. Be sure to read the directions on the bottle to give the correct dosage for your child’s height and weight.

Footwear: Always wear a well-cushioned pair of supportive shoes. Do not walk in bare feet. In some cases, special gel inserts for the shoe called heel cups may help.

Stretches: Stretching the calf muscles can help loosen tight Achilles tendons and help decrease the pull of the tendons on the growth plates. Some easy stretching exercises are shown below.

Do these stretches along with your child. This can make it more fun for both of you and may help your child want to do them.

Do these exercises three times each day:

1) as soon as you get up in the morning

2) in the afternoon (after lunch or after school)

3) before going to bed at night.

  • With the knee straight, have an adult gently bend the child’s foot up towards the belly, stopping when you feel it get tight (Picture 1). Repeat with the other foot.

Hold each stretch for 30 seconds. Repeat 10 times.

  • Stand facing a wall. Lean towards the wall and place the hands on the wall for support. Bend one knee. Stretch the other leg out behind you. Keep the leg you are stretching straight (Picture 2). Switch leg positions and repeat, stretching the other leg.

Hold each stretch for 30 seconds. Repeat 10 times.

  • While seated on the floor, take a towel, sheet or belt and hold the ends in both hands. Loop the towel around the ball of the foot. Keep the knee straight and pull the towel towards you until you feel a stretch in the calf muscle (Picture 3).

Hold each stretch for 30 seconds. Repeat 10 times.

Recovery

Recovery from Sever’s disease varies from patient to patient. In most cases, Sever’s disease goes away on its own with rest, treatment, and time. Symptoms may worsen if your child tries to play through the pain or if proper treatment is not followed.

Your child may increase activity when symptoms have subsided. Sever’s is a disease, however, that can come and go.

Your child should continue stretches regularly to try to help prevent reoccurrences. Sever’s disease typically goes away completely when the growth plates close.

When to Call a Healthcare Provider

If your child has or develops any of the following symptoms, he or she should be seen
by a healthcare provider:

  • Severe pain that does not improve or go away with rest
  • Fever higher than 101.4 degrees Fahrenheit, taken by mouth
  • Severe swelling or redness to the heel
  • A specific injury to the area.

Sever's Disease (PDF) HH-I-342 1/16 Copyright 2016, Nationwide Children’s Hospital

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