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

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

Naturally, any pain is a health concern. On top of that, though, this problem causes many kids to stop playing favorite sports and participating in activities they normally enjoy.

Fortunately, we have some good news:

While child heel pain is common – even our own Dr. Leibovitz was affected when he was young – it’s also highly treatable.

And, even better, most cases do 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?

If your son or daughter has heel pain, the most likely culprit is a condition known as Sever’s disease (or calcaneal apophysitis, if you want to be technical).

As you’ll see, this isn’t actually a disease. It’s more a “growing pain” that keeps your child from staying active and enjoying favorite sports.

Although the same foot mechanics and Achilles tendon tightness are present in both adult and adolescent heel pain, the difference for kids relates to their bone growth center (apophysis) at the back of the heel (calcaneus).

In this case, the core issue is related to differences in growth rates.

Specifically, when the apophysis reaches physical maturity earlier than the Achilles tendon, it causes tightness and tugging on the heel bone.

The main problem here is similar to what adults can experience, even if a grownup’s tightness and tugging has a different root cause.

And this will produce different symptoms for youngsters.

How can you recognize child heel pain?

Not all children are forthcoming when it comes to letting you know about pain and health issues. And that means it’s important for you to know how to tell if your child’s heel hurts.

This juvenile version of plantar fasciitis occurs in girls and boys below the age of 14.

It’s marked by progressing pain around the outer, back part of the heel. The area will be tender at the beginning – as well as the end of – physical activity. There is typically mild-to-moderate improvement in comfort during the course of exercise.

An affected child will have extraordinary discomfort when the back of the heel is bumped on a hard surface.

Symptoms generally present toward the end of a sports season or when going directly from one sport to another (such as soccer to basketball) with little rest or recovery time.

How does heel pain affect how your child walks?

You can identify a tight Achilles tendon by watching your child walk. You should be able to see a distinct “bouncy” gait (because the heel is coming off the ground early). The foot may also roll in (“pronate”) a great deal.

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.

Now think about how your 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 the adult version of heel pain – both the mechanics of the foot and tightness of the Achilles tendon must be addressed.

Kids do have some advantages, however:

One is that the connective tissue adapts more quickly than an adults’, and that flexibility provides relief much sooner (7-14 days).

Another advantage for a growing child is their bones are soft and can be changed if they are held in a better position. The earlier bad mechanics can be addressed in a child, the greater potential there is to change the bone structure – and avoid the need for aggressive surgery down the road.

For that reason, orthotic therapy might be a recommended course of treatment for this condition.

Please keep in mind:

Once the growth center has completed its job, it will disappear and the peripheral heel pain will go away, but the adult version is not far away if the problem wasn’t addressed properly.

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 get your child back to his or her active lifestyle!


9505 E. 59th St., Suite A
Indianapolis, IN 46216

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(317) 545-0505

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