What is Sever's Disease of the Heel Bone?

The most common cause of heel pain in adults is a condition known as plantar fasciitis which make up to 90% of the cases. When it comes to children, plantar fasciitis is actually very uncommon and the most common cause of heel pain in children being a condition known as Sever’s Disease. This is really bad terminology as its not a disease and the use of that word can have very negative consequences. There is also a trend away from the use of descriptions of conditions from being named after people, typically the doctor who first described the condition. The more appropriate name for the condition is calcaneal apophysitis. It is a condition of the growing area at the back of the heel bone or calcaneus.

When we are born, most of the bones are still a soft and pliable cartilage framework that the bone develops within. For the heel bone growth starts from the centre and expands to full up the whole area of that cartilage framework. However, there is still a cartilage growth area at the back of the heel bone that growth and development continues to happen at. That small growth area at the back of the heel bone is prone to damage if stresses on the heel bone are high.

The main risk factors are a higher body weight, being taller and having a more active lifestyle such as playing more sport. Some also suggest that tight calf muscles are a factor, but that is not always a consistent finding. The condition is more common in the ages of 8 to 12 years. The growth area of the heel bone combines with the rest of the bone around the middle of the teenage years, so whatever happens it is not possible to have this condition beyond that age.

The symptoms of Sever’s disease will tend to start out as a slight ache at the back of the heel bone that gets worse over time and is more painful with increased activity. It typically gets worse with increased activity levels with pain levels not necessarily the same from day to day and vary depending on activity or sports participation levels. A classic sign of this condition is pain on the sides at the back of the heel bone if you squeeze it between the fingers. There are no x-rays or other imaging that can be used to help diagnose this and the diagnosis is based on the clinical findings.

The main approach to treating Sever’s disease is education of the child and parents about the nature of the condition and its self-limiting nature. Lifestyle and sports activity levels are going to need to be reduced so the load on the growing area is reduced to tolerable levels. Ice can be used after sport if the pain levels are high. If the calf muscles are tight, then a stretching program can be used to increase the range of motion. A cushioned heel raise is often also very helpful. In most cases it is a matter of doing these treatments and managing the activity levels and wait for it to take its natural path and eventually get better.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.