Calcaneal apophysitis (Sever?s disease) is the most common cause of heel pain in young athletes. Calcaneal apophysitis is a painful inflammation of the heel?s calcaneal apophysis growth plate,
believed to be caused by repetitive microtrauma from the pull of the Achilles tendon on the apophysis. Patients with calcaneal apophysitis may have activity-related pain in the posterior aspect of
the heel. 60 percent of patients report bilateral pain. This condition is usually treated conservatively with stretching and arch supports. The young athlete should be able to return to normal
activities as the pain decreases. Calcaneal apophysitis (Sever?s Disease) may last for months. Increasing pain, despite measures listed below, warrants a return visit to the physician.
The cause of Sever's Disease is not entirely clear but it is most likely due to repeated minor trauma that occurs during high-impact activities that involve running and jumping such as soccer,
basketball, and gymnastics. It may also occur when an active child regularly wears shoes with poor heel padding, shock absorbency, or poor arch support. Some additional contributing factors are
excessive pronation, an overly tight calf muscle, and other flaws in the biomechanics of a child's walking stride. Children who are overweight are also at greater risk of developing Sever's
Pain symptoms usually begin after a child begins a new sport or sporting season, and can worsen with athletic activities that involve running and jumping. It is common for a child with Sever?s
disease to walk with a limp. Increased activity can lead to heel cord tightness (Achilles Tendon), resulting in pressure on the apophysis of the calcaneus. This will cause irritation of the growth
plate and sometimes swelling in the heel area thus producing pain. This usually occurs in the early stages of puberty.
Sever condition is diagnosed by detecting the characteristic symptoms and signs above in the older children, particularly boys between 8 and 15 years of age. Sometimes X-ray testing can be helpful as
it can occasionally demonstrate irregularity of the calcaneus bone at the point where the Achilles tendon attaches.
Non Surgical Treatment
If your child is diagnosed with Sever's disease, treatment is fairly straightforward. He or she should avoid any activities that cause a flare-up of heel pain. Treat the pain with ice for 20 minutes,
three times a day. If the pain is severe, over-the-counter pain relievers such as acetaminophen or ibuprofen can be used for a short period of time. (Don't use aspirin in a child or teen because it
can result in a rare but life-threatening condition called Reye's syndrome.) In some instances, a child might have other foot problems, as well, such as high arches, flat feet, or bowed legs. In
these instances, your doctor can recommend an orthotic device to help further prevent the pain related to Sever's disease. One other simple tip that can prevent Sever's disease or speed along
recovery is for your child to wear supportive shoes and avoid going barefoot as much as possible.
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel.
Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and
inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a
cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence
of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle