Children’s Heel Pain (Sever’s Disease) - Jeffrie C. Leibovitz, DPM

Sever’s Disease (Calcaneal Apophysitis) – Heel Pain in Children

The Most Common Cause of Children’s Heel Pain is a growth plate injury  

We know you want your children to be healthy and happy. Of course, children’s heel pain can keep both of those from happening. 

Children’s heel pain is most likely Sever’s disease (calcaneal apophysitis) and it is a common problem in a developing foot. This isn’t actually a disease, but more of a “growing pain” that keeps your pre-teen from activity and enjoying their favorite sports. Even our own Dr. Leibovitz was affected when he was young and he wishes he knew then what he knows now. 

Fortunately, we have some good news:

And, even better, it does NOT require surgery!

Feel free to keep reading to learn more about this problem and the conservative treatment options we offer. Or, if you’re ready to schedule an appointment for your son or daughter now, please call our office at (317) 545-0505 or contact us online.

Why does your child’s heel hurt?

The same mechanics that produce heel pain in adults is also found in adolescents. The difference is that kids have an active bone growth center (apophysis) in the back of the heel (calcaneus) which can get irritated. 

In an adult, damage will occur in the soft tissue (the plantar fascia). In a growing kid, the same mechanics damage this growth plate. A child’s heel pain will be more generalized around the back and sides of the heel. An adult’s heel pain will be isolated on the bottom and slightly more towards the inside.

The growth center can be compared to a peanut and butter and jelly sandwich. When you squeeze the bread, the PB&J become compressed and push out the side of the sandwich. This is what happens to the growth plate when the Achilles tendon is tight and the foot rolls in. Pronation (excessive rolling of the foot inward while walking) will tighten the plantar fascia and the growth plate gets the same treatment as the PB&J. 

An X-ray will show growth plate damage as irregular margins at the back of the calcaneus. It may even look like a mouse has been chewing on the bone. This can easily be misdiagnosed as a fractures by someone not familiar with this problem.

The apophysis will stop growing and disappear at around 12 years for girls and 13 years for boys. The effects of pronation and a tight Achilles tendon will now affect the plantar fascia, as in an adult.

How can you recognize the pain from an inflamed growth plate?

Children may not let you know about their pain and health issues. And that means it’s important for you to know how to tell if your child’s heel hurts. 

What you will find is pain around the peripheral area of the heel. A child will have extraordinary discomfort when the back of the heel is bumped on a hard surface. If you want to get your child’s attention, sneaking up and squeezing the back of their heel would be a dastardly yet effective thing to do. 

There will also be discomfort at the beginning – as well as the end of – physical activity. There is typically some improvement during exercise.

If your child plays sports, the intensity of symptoms will increase at the end of a season. It does not help when the outdoor playing fields get concrete hard at the end of summer, either. There can be a little improvement between sports but symptoms return with a vengeance when the next activity starts.

How does heel pain affect how your child walks?

You will notice a protected gait after activity. That means they will walk funny, like Chester from the TV show Gunsmoke. (I guess I am showing my age.)

The tightness in the Achilles tendon is called an “Equinus.”  You can identify a tight Achilles tendon by watching your child walk. It shows as a distinct “bouncy” gait, because the heel is coming off the ground early. 

The foot may also roll in (pronate) too much. As your child walks away from you without socks or shoes on, observe the Achilles tendon. Look for a bending or bowing of the tendon away from the midline of the body. This is rear foot pronation

When watching your child walk toward you, look for a dropping of the arch and a bulge in this area.
Also watch the child’s biological parents and grandparents walk. You will know who to blame for this problem. (There is a strong hereditary influence for the mechanics of the foot, and the apple does not fall far from the tree.)

How can we help your child find relief from heel pain? (Sooner treatment is better!)

Rest can help, but unfortunately the discomfort will return with activity. The treatment for Sever’s disease is very similar to adult heel pain. Both the mechanics of the foot and tightness of the Achilles tendon must be addressed in both age groups.

There are some great advantages of being a kid. Soft tissue is very flexible and adapts quickly. You can see improvement in 10-14 days in a child that takes an adult 30 days to achieve. (Flexibility is wasted on the young.)

Another advantage is a child’s bones are soft and can be changed if held in a better position. The earlier bad mechanics can be addressed in a child, the greater potential for change in the bone structure. 

If enough correction occurs in the early developmental years, many adult problems could be eliminated. For that reason, orthotic therapy might be a recommended course of treatment for this condition.

Something to keep in mind

Once the growth center has completed its job, it will disappear. The peripheral heel pain will go away, but the adult version is not far away. We have 10 years of growth to change the foot structure in a 4-year-old and only 1-2 years to help a 12-year-old. Bone changes, but it changes very slowly.

Do you have a child between 6-14 years old? Does this sound familiar? Request an appointment for proper diagnosis and treatment at our Indianapolis foot doctor office today.

Simply give us a call at (317) 545-0505 and we will help your child get back to their active lifestyle.

Child with Severs Disease