By: DR. BROOKE GIFFORD
Sever’s disease describes a condition in which the growth plate of the heel bone is inflamed. The majority of the heel bone is present at birth then around 8 years of age a secondary growth center develops. This new piece of bone is crescent shaped and is connected to the remainder of the heel bone by a layer of cartilage which is the growth plate (medical term is “apophysis”). The Achilles tendon inserts on the secondary piece of bone so that every time the Achilles tendon moves, it pulls on that piece of bone and subsequently the growth plate. In children who are very active in sports and running, the growth plate can become inflamed and cause heel pain. This pain can come and go over the course of several years while the growth plate is open. Sever’s disease is self-limiting because the growth plate will eventually turn into bone around 14 years of age. It is important to know that although running, playing and sports may cause pain, it does not harm or damage the growth plate.
Pain is most often localized to the back of the heel but can also be in the bottom; however, unlike adults with plantar fasciitis, the pain is towards the back of the heel rather than in the center or towards the arch. Usually the skin looks normal around the heel but occasionally there is redness and swelling associated with the pain. As the inflammation and pain progresses the child may start to limp and eventually not want to participate in anything that involves excessive walking or running.
A tight Achilles can contribute to Sever’s disease so it is important to do Achilles stretches daily. Heel lifts in a stable running shoe are recommended. Orthotics (arch supports in the shoes) are sometimes warranted to limit pronation which decreases torque on the Achilles and thus less pull on the growth plate. Sever’s disease is an inflammatory problem so icing the heel for 20 minutes daily is advised (and always after practice and games). Oral or topical anti-inflammatories can also be helpful. Biofreeze, Arnica or Traumeel are examples of cream or gel topical anti-inflammatories which are helpful if the child cannot swallow pills. Immobilization in a fracture boot or cast for 2-4 weeks is reserved for more severe cases if the child is limping all the time. Barefoot walking should be avoided when possible and instead opt for a running shoe which has more height in the back than the front which decreases tension on the Achilles and takes more pressure off the heel by directing it more towards the ball of the foot. Avoid flip-flops and other unsupportive shoes.
Heel pain in children is not always Sever’s so it’s important to be diagnosed by a foot and ankle specialist.