Sever's Disease

Severs Disease is a common cause of heel pain in children. It is seen most commonly in children aged 5 - 11 years old.

Children with Severs Disease will complain of heel pain that increases with activity. The pain is often relieved by rest, although some children will continue to have pain with regular activities, such as walking.

Severs Disease has much in common with Osgood-Schlatter Disease. Both are described as being a traction apophysitis.

The Achilles tendon (heel cord) attaches to the calcaneus (heel bone) near the calcaneus growth plate. The tendon can place stress on the growth plate, which can cause inflammation and pain.

On physical examination, there is often tenderness over the calcaneus growth plate. Often, the Achilles tendon may be slightly contracted. A contracted Achilles tendon, may place more stress on the growth plate.

X-rays of the heel are taken to make sure there aren’t any fractures or stress injuries present. The x-ray may show irregular calcification of the calcaneus at the growth plate.

The treatment of Severs disease focuses on relieving any pain the child may feel and preventing any other episodes of pain from developing.

If the child’s pain is severe and they cannot walk without significant limp, I will often place the child in a walking cast for several weeks to allow the inflammation to decrease and get them to be able to walk without pain.

If the pain is mild or just felt with activities, I will start activity restrictions, use medications such as Advil or Motrin, and have the patient get heel cups to put in their shoes. The heel cups provide a little cushioning for the heel and raise the heel in the shoe, thereby, shortening the Achilles tendon slightly.

The most important aspect of treatment is Achilles tendon stretching. If the Achilles tendon is tight, it will put extra stress on the calcaneus growth plate, since it inserts on the calcaneus very close to the growth plate.

Stretching is also very important to prevent future episodes of pain.

A child can participate in activities as tolerated. Children do not get worse injuries from this condition.