Heel pain in children

Children are prone to pain in numerous areas when growing, one of which is the heel. This can be because of Severs disease, which is characterized by pain in the heel area where the Achilles attaches to the bone.

Sever’s disease, despite its name, is not actually a disease but rather a common heel condition that affects growing children, particularly those active in sports. Also known as calcaneal apophysitis, Sever’s disease is characterized by pain in the heel area, specifically where the Achilles tendon inserts into the heel bone (calcaneus). This condition commonly occurs during or after recent growth spurts, typically between the ages of 8 and 15 years old, when the heel bone is still developing and is more vulnerable to stress and injury.

What causes Sever’s Disease?

Sever’s disease is caused by repetitive stress and tension on the growth plate of the heel due to traction of the Achilles tendon. This stress is typically experienced during activities such as running and jumping sports. The repeated stress on the still-growing bone from the pulling of the Achilles tendon can lead to pain and inflammation in this area.

Several factors can increase the risk of developing Sever’s disease including:

• Age and growth: Sever’s is common between the ages 8-15 and typically occurs during or after rapid growth where the bones are growing faster than the tendons/muscles leading to tractioning at their insertion.
• Physical activity: Sports that have lots of running and jumping such as basketball increase stress on the heel.
• Footwear: Shoes that are worn down, have limited support, or are not fitting properly can contribute to heel pain.
• Foot anatomy: Having a flat lower arch or a higher arch can alter the loading through the foot and impact the heel.

Symptoms of Sever’s Disease:

The main symptom of Sever’s disease is pain in the heel. This is typically worsened by weight-bearing activities, particularly running and jumping. Children may start to limp or alter walking biomechanics to avoid irritation to the heel.

Diagnosis and Treatment

If you suspect your child has Sever’s disease it is important to get a correct diagnosis from a Physiotherapist. Sever’s disease is typically diagnosed based on a physical examination and the child’s symptoms. Your physiotherapist will conduct a detailed subjective assessment to get a gauge of what the pain is like, the location and what activities aggravate or ease the symptoms.

Following this, a physical assessment will be conducted. This will likely include a gait assessment to see if there are any compensations in the walking pattern, functional movements that load through the heel such as calf raises, jumping and, hopping as well as palpation around the heel to determine the source of pain.

Imaging may be utilized to rule out other conditions if they are suspected, such as fractures.

Treatment for Sever’s disease varies from child to child based on their symptoms. Children will grow out of this condition as their muscles and tendons continue to grow and reduce traction on the heel. However, a rehabilitation plan can decrease the effects of this condition and allow children to continue to play their chosen sport with less pain.

Treatment typically involves release work throughout the calf, such as massage and stretching to reduce tightness and therefore traction on the heel. Treatment, if the severity of the pain is high, will also include load management of the child’s sport to reduce irritation. Outside of this, changes can be made to footwear by a Podiatrist to better support the heel.

Although a painful condition, Sever’s disease is a temporary condition that resolves over time. For the most part, children can continue to play their chosen sport with this condition however modifications of load may need to be considered in more severe cases. If you think your child may have this condition, make sure to book in today and get an assessment!

 

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