Your Child Has Heel Pain? (Sever's Disease) - Jeffrie C. Leibovitz, DPM

Your Child Has Heel Pain? (It’s Probably Sever’s Disease.)

Have you ever experienced pain in the back of your foot and thought:

“Eh, that’s just a normal part of getting older.”

The problem with that kind of thinking is twofold. First, heel pain isn’t “normal.” (Remember, pain is actually a gift your body provides so you can become aware that somethings wrong!) Second, this is a legitimate health issue—and it’s one that isn’t limited exclusively to adults.

Heel Pain: Not Just an Adult Problem!

Pretty much every parent out there knows that kids are in such a rush to grow up.  They like to focus on our independence and disposable income and look past responsibilities of jobs, taxes, mortgages, etc.

Well, kids may get a part of the adult experience—something which can often include stepping into the ring with plantar fasciitis (the leading source of adult heel pain)—then Sever’s disease will give them a swift slap upside the head.

And when we talk about this particular subject, it’s worth noting that Sever’s is a common problem for children and adolescents.

In fact, this is actually something your favorite go-to foot doc here in Indianapolis had himself back when he was a young lad. As such, he has firsthand experience with how much pain and difficulty the condition can cause.

Accordingly, we know what we’re talking about when we say this condition is basically plantar fasciitis for the younger crowd!

There is a small difference, though, since the pain is mostly felt in the peripheral margins of the heel with Sever’s. (Adults with the discomfort from plantar fasciitis is primarily experienced in the bottom of the heel.)

Let’s take a closer look at this condition so you can understand how to recognize it and what we can do to treat it.

Why Your Child Has Heel Pain

Going back to something we mentioned in the opening is that heel pain is a common issue. So why is this the case?

Part of the reason behind heel pain’s commonality—and the American Podiatric Medical Association puts heel pain atop their list of “Persistent Foot Ailments”—can be attributed to there being a variety of potential root causes.

Often, those causes are related to the connective tissues anchored to the heel bone (calcaneus)—specifically, the Achilles tendon and plantar fascia:

  • The Achilles tendon is attached to the back of the calcaneus and connects it to the the calf muscle (so we can move our feet up and down).
  • The plantar fascia is attached to the bottom of the heel bone and connects to the front of the foot (thereby helping to create and support our foot arches).

Problems start to develop in adults when these tissues are tight and face excessive strain. When strained too often, the tissues can sustain tiny rips and tears—and this can be rather painful.

The connective tissues (ligaments, tendons) in the adult musculoskeletal system can be like older rubber bands, ones that have a lot of wear after being stretched numerous times throughout the years or brittleness from lack of use.

You can see this if you grab an older rubber band from your desk. You’ll likely observe a certain degree of tearing along the band’s edges. Further, it’s also lost a decent amount of its former elasticity as well, right?

But that’s not the case with a child’s ligaments and tendons, so why do they develop heel pain? After all, their connective tissues should be like newer rubber bands!

Well, they certainly are … In fact, the soft tissue can be stronger than bone.

Going back to those important tissues anchored to the heel bone, the bigger culprit behind child heel pain often tends to be the Achilles tendon.

So what exactly is tugging on your child’s Achilles?

A True Growing Pain

Essentially, the problem can be attributed to a growth plate found in the back of the heel—the calcaneal apophysis. And until this growth plate completely solid when it reaches physical maturity it can be irritated and compressed by the Achilles tendon.  A combination of the Achilles tendon in the plantar fascia compress the growth plate causing irritation.

(On account of that, the fifty-cent term for the condition is “calcaneal apophysitis.”)

With regards to this fancy-named growth plate, an x-ray of a “normal” heel bone with an active growth plate should show a clear curving, line. For a kid who has Sever’s, the same x-ray would look more like a jagged saw with possible fractures extending to the growth plate.

The good news is that, in spite of the fractured and irregular appearance, this doesn’t actually affect the plate’s growth.

When does this typically happen?

Normally, the condition can start to develop as early as age 8 and last until around 12 (for females) or 13 (for males).

Variables that contribute to this condition:

  1. Mechanics passed down genetically—and especially heavy pronation patterns
  2. Activity levels
  3. Tightness of Achilles tendon

There is one more factor we should note—footwear. Basically, shoes that minimize heel raise (such as those worn for soccer, ballet, etc.) can also play a role in Sever’s disease.

As an interesting note, up until around the late 1970’s, this was an issue that was almost exclusively seen in boys. The current distribution is still a little heavier for that particular gender, but the gap has become much closer.

So what changed?

Well, that’s around the time girls started having more opportunities to participate in sports. As with everything in life, there are pros and cons—and in this case the “pro” of more opportunities came with the “con” of more injury risk.

What Can We Do About It?

Left untreated, the child will eventually develop plantar fasciitis as a young adult (Moms, don’t let your children grow up to be cowboys…or have a case of plantar fasciitis that could have been prevented!)

For those reasons, a couple of treatment options that often deliver high success rates are custom orthotics and a proper stretching routine.

The orthotics can help correct abnormal motion—which, in turn, can prevent future problems from rearing their ugly heads—and the right stretches will alleviate Achilles tendon tightness.

In fact, those options, when combined, can often get your child back to normal activities within only 1-2 weeks.  Unfortunately, kids can be treated by stopping their activity so they can get better.  Symptoms return shortly after activity resumes.  We find it is important to maintain activity during treatment so we know the treatment plan is going to be successful.

A great benefit of youth is there inherent flexibility of soft tissue.  Measurable improvement in an adult Achilles tendon may take up to 4 – 6 weeks while it may take only 10 – 14 days for your child.

(Flexibility is wasted on the youth!)

What Happens If You Don’t Address the Problem?

After around 12 or 13, there will be a “grace period” of a couple of years when your child doesn’t have heel pain anymore.

But don’t sit back and breathe a sigh of relief just yet!

What will often happen is a reemergence of heel pain somewhere during the years of 18-20—at which point your (now grown) child has graduated to adult plantar fasciitis. And the explanation for the time between is simply that’s how long it takes the tissues to get beat up.

Now, take a moment and consider this:

Dependents can stay on your insurance until the age of 26.

That means you can either pay now or pay later to have the problem resolved—but it’s easier (and cheaper!) to treat when your child is young.

child heel pain graphic

Recognizing Symptoms

With regards to the presenting symptoms, we often find that athletes—and especially soccer players, gymnasts, and runners (likely attributable to the footwear and amount of running required by the sport)—will start to experience problems later in the season.

In the same spirit, heel pain tends to be worst in the middle-to-end of physical activity. (Adult heel pain is significant with the initial steps following a rest period.)

We also want to note that the pain isn’t always connected with physical activity. Sometimes accidentally contact around the heel can be quite painful.

Contrary to what some parents might think, if your child has Sever’s, he or she is not faking with regards to the pain. This is a condition that really hurts—and I can fully attest to that. And because this is the case, there might be some complaining, whining, and/or irritability.

If your child doesn’t complain about pain—and children are sometimes reluctant to speak up about something like this—one potential telltale sign is if he or she starts walking kind of funny. If you observe an altered gait, what you’re seeing is your son or daughter taking measures to avoid pain.

And speaking about “altered gaits,” it’s worth emphasizing that overpronation is a serious red flag for this particular issue.

If you just aren’t sure whether or not your child has Sever’s you can try gently squeezing a potentially affected heel. This will cause a tremendous amount of pain, and likely give you a definitive answer.

Your child’s reaction can potentially erase all doubt! Depending on the recent behavior of your child, this may make you feel terrible…. or not.

Get Your Child the Help He or She Needs!

We cannot emphasize this nearly enough:

If heel pain is keeping your son or daughter away from favorite activities, bring him or her in for an appointment. In doing so, you are both giving your child the opportunity to become active again and preventing larger issues from developing in his or her future.

Your child means the world to you. We know it hurts you when they’re in pain. Take action and do something about this today—connect with our office by either calling (317) 545-0505 or use our online form and contact us right now!