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  • Writer's pictureDavid Weiss, DPM

Calcaneal Apophysitis and heel pain for kids

courtesy photo

Sever’s disease is a condition that affects kids, especially growing children that are active in sports. It is an inflammation of the growth plate in the heel. Sever’s disease is caused by repetitive stress to the heel most often occurring during growth spurts when bones, muscles, tendons, and other structures are changing rapidly. Children and adolescents who participate in athletics—especially running and jumping sports such as soccer—are at an increased risk for this condition. It can happen to other patients like less active adolescents who may also experience this problem, especially if they wear very flat shoes. Patients with flat feet are more susceptible in this case.

In most cases of Sever’s disease, simple measures like rest, over-the-counter medication, and a change in footwear will relieve pain and allow a return to daily activities. In addition, stretching the calf muscles may help decrease the stress on the heel.

The bones of children and adolescents possess a special area where the bone is growing called the growth plate. Growth plates are areas of cartilage located near the ends of bones. In the heel the growth plate is where the Achilles tendon inserts.

When a child is fully grown, the growth plates close and are replaced by solid bone. Until this occurs, the growth plates are weaker than the nearby tendons and ligaments and are susceptible to trauma. Sever’s disease affects the part of the growth plate at the back of the heel. This growth area serves as the attachment point for the Achilles tendon — the strong band of tissue that connects the calf muscles at the back of the leg to the heel bone.

Repetitive stress from running, jumping, and other high-impact activities can cause pain and inflammation in this growth area of the heel. Additional stress from the pulling of the Achilles tendon at its attachment point can sometimes further irritate the area. This condition is commonly seen in soccer where cleats do not offer support and there is increased stretching of the Achilles tendon.

Painful symptoms are often brought on by running, jumping, and other sports-related activities. In some cases, both heels have symptoms, although one heel may be worse than the other. Symptoms may include heel pain, swelling, and tenderness underneath the heel.

I recommend visiting the doctor when home care consisting of icing and stretching no longer work. If home care fails, I will examine the patient to assess why this continues to occur. X-rays may be taken to see if any other problems can be causing the discomfort. In addition, a physical examination can help to aid in diagnosis.

Treatment for Sever’s disease focuses on reducing pain and swelling. This typically requires limiting exercise activity until your child can enjoy activity without discomfort or significant pain afterwards. I am fond of saying “If it hurts when you do that, don’t do that” which applies here. In some cases, rest from activity is required for several months, followed by a strength conditioning program. However, if your child does not have a large amount of pain or a limp, participation in sports may be safe to continue.

Alternative treatment methods include heel pads. Heel cushions inserted in sports shoes can help absorb impact and relieve stress on the heel and ankle. Custom orthotics can be used to offload the heel and reduce the pronation that contributes to the pain. Wearing shoes with a slightly elevated heel. Elevating the heel may relieve some of the pressure on the growth plate. NSAID’s and drugs like ibuprofen and naproxen can help reduce pain and swelling. Exercises can help to stretch the calf muscle and strengthen the leg muscles once pain has decreased. In cases where the pain is bad enough to interfere with walking, a “walker boot” might be required to immobilize the foot while it heals.

It is not unusual for Sever’s disease to recur. This typically happens when a child once again increases sports activities. Wearing sports shoes that provide good support to the foot and heel may help prevent recurrence. Sever’s disease will not return once a child is fully grown and the growth plate in the heel has matured into solid bone.

To make an appointment or for more information, call Weiss Foot and Ankle Center at (609) 561-2488 or go to David Weiss, DPM, is the owner of Weiss Foot & Ankle Center located at 777 South White Horse Pike, Suite D1 in Hammonton.


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