Heel Pain in Kids? It Might Be Severs Disease

heel pain severs disease

Heel pain in kids is not uncommon – and who can blame them? They’re at school, jumping and running around, but are often pretty resilient to injuries and falls. It would grab a parent’s attention if their child is complaining of calf/heel pain consistently over a week or even on and off for a few weeks/months.

Severs disease might be the culprit here, and this blog will discuss what Severs disease is (and why it’s not actually a disease), how it’s assessed, other causes for heel pain and treatment and management of the condition.

What is it?

Severs Disease is also known as calcaneal apophysitis, which means inflammation at the heel bone.

Severs usually occurs in kids who are physically active and play lots of sport, and therefore the growing calf muscle and tendon can pull on the calcaneal growth plates (where the heel is still growing) and cause inflammation. It’s more common in boys and generally occurs in those aged 8-14 years. It can also occur because the tibia is growing too fast and the calf muscles haven’t caught up yet, therefore also causing pulling on the heel. As the calf muscle strengthens and grows with the bones, the pain and inflammation will go away with time and some rest and basic stretches/strengthening exercises.

Symptoms of Severs disease include:

  • heel pain during/after exercise and sport
  • limping and tip-toe walking
  • pain in the heel that isn’t going away

Some other causes that are thought to increase the risk of Severs disease include: lots of sports and activity, finishing one sport and starting another, overuse of the calf muscles or “pushing through pain”, increase in sports training, and wearing low heel shoes, or shoes with studs. In summary, we can see that Severs isn’t actually a disease, but just heel pain related to growing bones and over-activity.

Assessing & Diagnosing Severs Disease

Our osteopaths and physiotherapists can assess for and diagnose Severs disease without GP referral or x-rays.

Assessment generally includes a thorough case history to understand what activity/how much activity the child is performing and what the pain pattern looks like. It also includes active muscle testing, in the form of testing calf strength and lower limb movement, as well as passive testing to assess how the joints are moving and ligament structures. It also involves palpation of the heel, calf and tendon, to feel for any areas of sensitivity and muscle tone/tightness.

Diagnosis is usually made by clinical judgement of all the information gathered in the history and assessment, and x-rays are not necessary to confirm diagnosis. X-rays are useful in ruling out any other conditions that may cause heel pain or serious conditions such as – major/minor fractures and osteomyelitis (bone infection). Other causes of heel pain include bursitis and juvenile arthritis.

Bursitis is inflammation of the cushioning that prevents rubbing of the bone and tendon at the back of the heel, usually also due to overuse and possibly tight shoes. Juvenile arthritis is a type of arthritis affecting children, for unknown causes, but is usually categorized by stiffness, swelling and systemic (or whole body) changes.

Treatment & Management of Severs Disease

Treatment and management of Severs disease involves an array of hands-on and hands-off management. As mentioned, this condition is self-limiting and will go away without complications. Severs will completely resolve once the growth plates close and all the muscles and bones have grown to their capacity. Either way, a visit to our osteopaths and/or physiotherapists is helpful to reduce pain using manual therapy and advice.

Osteopaths and physiotherapists are trained to assess and treat conditions relating to children like severs disease, and more importantly, can rule out major pathologies or direct children and their parents for further referral is necessary. Manual therapy using stretching and massage aids to lengthen and reduce tightness in the calf muscle for relief.

Advice surrounding patient education and reassurance, load management of multiple sporting activities, using effective warmups/cool downs and basic stretching/strengthening advice can help children better understand their body, manage their activity levels and bring some sought-after relief.

In conclusion, Severs disease isn’t a disease and is linked to growing pains and overactivity in very sporty kids. Although the condition is self-limiting, assessment and advice/treatment is still required to confirm the diagnosis and reduce pain. If your child is complaining about consistent heel pain or limps by the end of the day, our osteos and physios at 13th Beach Health Services can help out!

Written by Lana Mikovic – Osteopath
13th Beach Health Services