Sever’s disease, medically known as calcaneal apophysitis, is a common source of heel pain experienced by growing children and adolescents. It is primarily an overuse injury occurring in active individuals, typically between the ages of 8 and 15, who participate in sports involving running and jumping. This condition involves the inflammation of the growth plate located in the heel bone. While the condition is temporary and self-limiting, taping the heel offers a non-invasive method for temporary pain relief and mechanical support.
Understanding Sever’s Disease and Taping Rationale
Sever’s disease develops because of a mismatch in the growth rates of bone and soft tissue during a growth spurt. The heel bone grows faster than the surrounding muscles and tendons, particularly the Achilles tendon. This disparity results in increased tension and repetitive microtrauma where the tendon pulls on the softer, developing growth plate, leading to pain and inflammation. Activities like running and jumping exacerbate this traction force.
Taping provides a mechanical solution by physically limiting the range of motion in the ankle, specifically restricting dorsiflexion. Dorsiflexion is the movement that pulls the toes up toward the shin, stretching the Achilles tendon. Applying non-elastic, rigid athletic tape restricts this motion, reducing the pulling force exerted on the irritated growth plate. The wrapping technique also provides compression and support to the heel, offloading the painful area.
Materials and Preparation
To perform a supportive heel wrap, gather a few essential materials: non-elastic, rigid athletic tape (typically 1.5 inches wide), a roll of skin-protecting pre-wrap, and sharp scissors.
Proper skin preparation is necessary to ensure the tape adheres securely and minimizes irritation. The skin on the foot and lower leg must be clean, dry, and free of lotions or oils. Apply the pre-wrap smoothly over the entire area where the tape will be placed, starting above the ankle and covering the heel, avoiding wrinkles that could cause blisters.
Step-by-Step Guide to Heel Wrapping
Begin the application by placing two anchor strips of rigid athletic tape around the lower leg, approximately two inches above the ankle bones (malleoli). These strips should be applied with minimal tension and serve as the attachment points for the main support strips. The foot should be positioned in a slightly pointed-toe position (plantar flexion) to keep the Achilles tendon relaxed during application.
Next, create the supporting tethers, which are the strips that directly limit dorsiflexion. Starting from the top anchor, run three strips of tape down the back of the leg, over the Achilles tendon, and secure them to the bottom of the heel. The central strip should run down the middle of the tendon, and the outer strips should slightly overlap the middle one. Apply a small amount of tension to these strips to restrict the upward movement of the foot.
Secure these tethers by applying two more anchor strips over the bottom of the foot, wrapping them around the arch just behind the ball of the foot. The next step involves the heel locks, which provide lateral and medial stability. Starting on the outside of the ankle near the top anchor, pull the tape diagonally down across the back of the heel, under the arch, and back up to the inside of the top anchor. Repeat this pattern, starting on the inside of the ankle, pulling the tape diagonally down and under the arch, and back up to the outside of the top anchor.
Complete the wrapping with two or three figure-eight strips to secure the application and provide additional support. Start on the outside of the ankle, wrap medially across the top of the foot, under the arch, and then back up across the top of the foot to the starting point, creating an “X” pattern. Finally, cover any exposed pre-wrap with closing strips, starting from the top anchor and working down, to prevent the tape edges from peeling.
Complementary Management Strategies
Taping is an effective short-term measure, but it should be combined with other strategies for comprehensive management of Sever’s disease. Activity modification is often necessary, requiring a temporary reduction in high-impact exercises like running and jumping that aggravate the heel. Adjusting the training load allows the irritated growth plate time to recover.
Regular stretching of the calf muscles and Achilles tendon helps reduce the underlying tension contributing to the pain. Stretches should be performed gently and consistently after physical activity, but only once the acute pain phase has passed. Appropriate footwear is also beneficial; using shock-absorbing heel lifts or over-the-counter orthotics can cushion the heel and slightly elevate it, further reducing Achilles tendon strain.
If the pain persists, worsens, or is accompanied by severe swelling or difficulty walking, seeking advice from a healthcare provider is prudent. A medical professional can confirm the diagnosis and provide a personalized plan that may include physical therapy or other supportive devices. Since Sever’s disease resolves completely once the growth plate fuses, conservative management focused on pain control allows the athlete to remain active while the condition runs its course.