Children’s Heel Pain: Causes and Podiatry Treatments of Sever’s Disease

An Article Written By Cecilia Brennan
Podiatrist – New Step Podiatry.

 

Understanding Sever’s Disease: Managing Heel Pain in Active Kids

It’s finally happened. The day my active step child comes home reporting heel pain. Being a podiatrist I was able to easily manage this condition and hopefully you will feel the same after reading this article. As it turns out a few of her friends are experiencing the same heel pain, so please do share this information with parents of children aged 8 to 14.

 

What is Sever’s Disease?

Calcaneal apophysitis is the medical term for sever’s disease but it is quite a mouth full for many people so in this article we will continue to call this heel pain condition “sever’s disease” or “sever’s”.

Sever’s disease, is a common cause of pain at the back of the heel in children, particularly those aged 8 to 14. The condition is self-limiting, meaning, it will resolve eventually as your child grows and the growth plate attaches to the heel bone. It is more common in children who play sport, and the pain is more likely to occur after activity, particularly running and jumping. Children may experience tenderness, swelling or stiffness around the heel.

 

Why Does Sever’s Disease Occur?

During a child’s growth years, the bones, muscles and tendons are all growing at different rates. The Achilles tendon, which attaches the calf muscles to the heel, can become tight, pulling excessively on the growth plate in the heel bone. When combined with high-impact activities, this tension can lead to irritation, inflammation and the characteristic heel pain associated with Sever’s disease. Increased activity means more compression forces from ground impact and traction from the Achilles tendon, making active kids more susceptible to Sever’s disease.

Signs and Symptoms of Sever’s Disease

Your child may present with one or more of the following signs and symptoms of Sever’s disease.

• Pain and tenderness at the back of the heel, but not up in the Achilles tendon
• Swelling or redness in the area
• Limping or difficulty walking properly
• Stiffness in the heel, especially after periods of rest
• Pain that intensifies during or after sports

 

What Other Conditions Cause Heel Pain in Children?

While Sever’s disease is a leading cause of paediatric heel pain, there are other conditions to consider, including:

• Plantar fasciitis: Inflammation of the band of tissue running along the bottom of the foot.
• Heel fissures (cracked heels): Can cause discomfort but are generally surface-level issues.
• Achilles tendinitis: Inflammation of the Achilles tendon, often related to overuse.
• Fractures or stress fractures: Less common, but can occur from overuse or acute injury.
• Heel bursitis: Inflammation of fluid-filled sacs (bursae) in the heel area.
• Tarsal coalition: An abnormal connection between two or more bones in the foot, which can cause strain and pain.
• Osteomyelitis (bone infection): A bacterial infection in the bone can cause persistent pain and swelling.
• Juvenile Idiopathic Arthritis (JIA): Inflammatory conditions affecting joints can sometimes involve the heel or feet, leading to discomfort.
• Other rare causes such as a benign bone tumour like an osteochondroma and more serious conditions, such as Ewing’s sarcoma or osteosarcoma, which are extremely rare and would typically present with other symptoms beyond just heel pain.

A health professional assessment can determine the underlying cause of heel pain and ensure the right treatment plan.

 

Does my Child Need to Stop Playing Sport?

Participation in sports and activities is important for a child’s overall health and development. However, when heel pain arises, it may be necessary to modify activities to allow proper healing. A complete break may not be required, but reducing the intensity or frequency of high-impact activities can help. Low-impact exercises like swimming or cycling can maintain fitness levels without aggravating the heel.

Your child’s podiatrist can provide guidance on activity modification and safe return-to-play strategies. If you are struggling to manage your child’s heel pain , keep reading for tips on pain management.

 

What Can Help Ease the Pain of Heel Pain in Children?

There are several steps parents and caregivers can take to alleviate a child’s heel pain.

1. Rest and activity modification: Encourage breaks from high-impact sports and allow the heel to recover.
2. Icing: Applying ice packs to the heel for 10-15 minutes after activity may help provide analgesia.
3. Stretching exercises: Gentle calf and Achilles stretches may relieve tension on the heel’s growth plate.
4. Supportive footwear: Shoes with good arch support and shock absorption are crucial. Avoid worn-out athletic shoes that may worsen heel pain. Something you just need to buy a new pair rather than waiting for the child to grow out of the shoes.
5. Heel raises or gel cups: Inserting heel lifts or gel cups into shoes may reduce stress on the growth plate and provide immediate relief.
6. Topical and oral pain relief: Certain topical preparations containing Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) or natural anti-inflammatory agents can be applied directly to the painful area.
7. Oral pain medication: If the above options aren’t helping to reduce your child’s pain you may consider over-the-counter oral NSAIDs such as ibuprofen can help reduce inflammation and alleviate pain. Paracetamol, another over the counter option may provide pain relief but may not reduce inflammation. This can be useful if NSAIDs are not well-tolerated or contraindicated for your child. It’s important to follow the recommended dosage for your child’s age and weight and consult with a healthcare professional such as a pharmacist before starting any new medication.

What Can a Podiatrist Do to Help My Child’s Heel Pain?

Consulting a podiatrist is a proactive step in managing and treating paediatric heel pain. A children’s podiatry specialist can:

1. Provide a provisional diagnosis:
   A podiatrist will assess if your child is suffering from Sever’s disease or another cause of heel pain listed above. This ensure an appropriate treatment plan is provided.
2. Perform a biomechanical assessment:
   A thorough evaluation of your child’s foot function, gait, and posture helps the podiatrist understand the underlying causes of heel pain. Identifying issues like overpronation (rolling inward of the foot) or tight calf muscles ensures the correct treatment approach.
3. Orthotic therapy and footwear recommendations:
   Custom orthotics or heel cups may be recommended to provide additional support, reduce strain on the heel, and promote proper foot alignment. The podiatrist may also guide you in selecting the right type of footwear to prevent future problems.
4. Heel raises and supportive devices:
   Using heel raises, lifts or gel cups can help redistribute pressure on the heel and alleviate discomfort. These simple additions to your child’s footwear can make a significant difference in daily comfort.
5. Provide a personalised treatment plan:
   Every child is unique, and so is their heel pain. A podiatrist will create a tailored treatment plan, which may include stretching exercises, strengthening exercises, activity modifications and follow-up appointments to track progress. Early and appropriate intervention may shorten recovery time and ensure long-term foot health.

It should be noted that here at New Step Podiatry we don’t recommend laser therapy, shockwave therapy or achilles tendon lengthening surgery for calcaneal apophysitis for several reasons including that the condition is self limiting.

 

 

Preventing Future Sever’s Disease Related Heel Pain in Children

While Sever’s disease is often temporary and resolves as the growth plates close, prevention is always better than cure. Consider these strategies may help your child avoid future heel problems:

• Regular stretching: Encourage a daily stretching routine focusing on the calves, Achilles tendon, and feet.
• Proper footwear: Invest in well-fitting, supportive shoes and replace them as soon as they show signs of wear.
• Gradual progression in sports: Increase training intensity and duration slowly to help the body adapt without over-stressing the heel.
• Review your health professional plan: Is your child still following all the advice provided by the their podiatrist / physiotherapist / GP? If not, starting putting the plan back in action!

 

Getting Podiatry Help for Paediatric Heel Pain

Heel pain, especially caused by Sever’s disease, can impact a child’s daily activities, sports participation and overall comfort. Understanding the causes, recognising the symptoms and seeking help from a qualified children’s podiatrist as required are all steps that can be taken to help your child’s heel pain. Through proper assessment, supportive interventions and preventive measures, you can help your child stay active, healthy and pain-free.

 

Does Your Child Have Heel Pain? 

 

Our podiatrists are here to ensure those in Canberra have access to quality services that can help individuals get the treatment they deserve.

Easily BOOK ONLINE or give us a call on 02 6198 4818.

 

 

References

Liu, S., Williams, C. M., & Welch, J. J. (2023). International differences and inaccuracies in the public advertising about calcaneal apophysitis: An audit of websites originating in Australia, UK and USA. Journal of Foot and Ankle Research, 16(39). https://doi.org/10.1186/s13047-023-00637-9

Nieto-Gil P, MarcoLledó J, García-Campos J, et al. Risk factors and associated factors for calcaneal apophysitis (Sever’s disease): a systematic review. BMJ Open 2023;13:e064903. doi:10.1136/bmjopen-2022-064903