A guide for patients with Sever’s disease

What is Sever’s disease?

Sever’s disease (Calcaneal apophysitis) is a painful inflammation of the heel’s growth plate. It typically affects children between the ages of eight and 14. The heel bone is not usually fully developed until the age of 14 and, until then, can be irritated by growth and repetitive stress. Sever’s disease can affect one or both heels and is more common in boys. Pain from Sever’s disease usually gets worse with activity.

What are the symptoms of Sever’s disease?

• Pain in the back or bottom of the heel
• Walking on tip toes
• Difficulty with usual sporting activities
• Pain when the heel is squeezed from the sides

What causes Sever’s disease?

Heel trauma - being involved in lots of activities that include running and pounding hard surfaces causes a repeated trauma to the heel.  Children who regularly play lots of sport are vulnerable to this problem.

Tight Achilles tendon - the tendon that attaches to the heel bone (Achilles tendon) can pull on the bone if it gets tight.

Flat or high arched feet - having a flat or high arched foot affects the way the foot works and may make Sever’s more likely.

How is Sever’s disease treated?

Reduce activity levels

You can carry on with your sport but if the pain continues it is best to reduce the amount of activity you do.

Changes to footwear

Shoes that have a soft material at the back or open-backed shoes are best. Flat shoes should be avoided.

Ice

Putting an ice pack on your heel for five minutes during the day helps reduce inflammation. Place a towel between the ice and your heel. Do not apply ice directly to the skin.

Stretching

The podiatrist will advise you to do an Achilles tendon stretch daily as shown on the right.

Stand with your hands against a wall. Take a step back with one leg.  Make sure your heel is on the floor and knee is straight. You can bend the front knee if you want to increase the stretch. Hold the stretch for 30 seconds and repeat three times. You should carry out this exercise at least three times a day.

What other treatments are available?

Orthoses

Shoe inserts called orthoses may be prescribed if there is an underlying foot deformity such as flat feet.

Medication

A non-steroidal anti-inflammatory (such as ibuprofen) may help. Your pharmacist or doctor will be able to recommend the appropriate one for you.

Further information

There are no long term side effects from having Sever’s disease. Once the pain has gone and the bone has stopped growing, you cannot get it again. Having Sever’s disease will not affect the bone growth.

During active growth the pain can return, particularly if the Achilles tendon tightens again.