Sever’s disease (calcaneal apophysitis) is a common overuse injury causing heel pain in children and adolescents. It involves painful inflammation at the calcaneal apophysis, the growth plate located in the back of the heel bone. This condition results from repetitive mechanical stress and is frequent among young, growing individuals who participate in sports involving running and jumping.
What Sever’s Disease Is and Who It Affects
The underlying mechanism involves repetitive traction and microtrauma exerted on the vulnerable heel growth plate. The Achilles tendon attaches directly to this plate, creating tension whenever the calf muscles contract. During rapid growth, bone often grows faster than surrounding muscles and tendons, increasing Achilles tendon tightness. This heightened tension, combined with impact forces from physical activity, irritates the growth cartilage, resulting in inflammation and heel pain.
The condition most commonly affects physically active children aged 8 to 15, coinciding with a major growth spurt. Both sexes are affected, especially those involved in high-impact sports like basketball, soccer, and gymnastics. Primary symptoms include pain and tenderness in the back or bottom of the heel, which worsens during or immediately after activity. This pain may cause the child to limp or walk on their toes. Pain subsides with rest but returns when activity resumes.
Factors Determining How Long Symptoms Last
Sever’s disease is a self-limiting condition that resolves completely once skeletal maturity is reached and the heel’s growth plate fuses into solid bone. This fusion usually occurs in the mid-teens, often by age 15 or 16. Therefore, the total duration of the condition is tied to the child’s biological development.
While the overall condition may last for months or even a few years until the growth plate closes, acute painful flare-ups are much shorter. A single episode of pain often lasts from a few weeks to several months, depending on management and activity levels. The most significant factor influencing symptom duration is the child’s activity level and the load placed on the heel. Consistent participation in high-impact sports without modification prolongs the painful phase and increases recurrence.
Adherence to conservative management protocols, such as using supportive footwear and performing prescribed stretching exercises, directly impacts how quickly symptoms abate. The timing of the child’s growth spurts also plays a role, as periods of rapid growth increase Achilles tendon tension, making the heel vulnerable to irritation. Even with effective management, symptoms may return intermittently until the heel bone is fully mature.
Managing Pain and Activity Until Resolution
Management focuses on reducing pain and inflammation to allow the child to remain active without further irritating the growth plate. Initial short-term pain relief involves applying ice and using over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) to manage swelling and discomfort. Heel cushions or gel cups inserted into athletic shoes are an effective strategy, as these devices slightly elevate the heel to reduce Achilles tendon tension.
Supportive footwear, particularly shoes with a rigid sole and good cushioning, is an important measure to minimize impact forces during walking and sports. Children should avoid wearing flat shoes or going barefoot for extended periods, as this increases strain on the heel. Specific physical management involves daily stretching exercises for the calf muscles and Achilles tendon, which decreases the pulling force on the calcaneal apophysis.
Adjustments to the child’s physical activity schedule are necessary, as relative rest is a primary component of recovery. Complete cessation of all activity is rarely required, but high-impact activities like running and jumping must be limited or avoided if they cause pain. Encouraging participation in non-weight-bearing activities, such as swimming or cycling, helps maintain fitness without stressing the heel, allowing the inflammatory process to settle until the growth plate naturally fuses.