Unlike adults, heel pain is very uncommon in children. When children do experience heel pain, it is highly likely to be caused by a disturbance to the growth plate in the backof the heel bone
(calcaneus), where the Achilles tendon attaches to the heel. This disturbance is known as Sever?s disease or calcaneal apophysitis (inflammation of the growth plate). Sever?s disease is most common
between the ages of 10 and 14 years, and it is one of several different ?osteochondroses? that may occur in other parts of the body, such as at the knee, such as Osgood-Schlatters Disease. This
condition occurs in children because they are still growing and their bodies harbor many ?growth plates?. A growth plate, also called an epiphyseal plate, is an area at the end of a developing bone
where cartilage cells change over time into bone cells. As this occurs, the growth plates expand and unite, which is how bones grow.
At birth, most of our foot bones are still made of cartilage, which ossifies (becomes bony) over the first few years of life. At the back of the heel, there is a growth plate that is attached to the
main body of the heel bone by a cartilaginous join. At about the age of 14-15 years, this area of cartilage between the growth plate and the heel bone ossifies, fusing the area to the heel. Sever?s
disease occurs when there is too much motion or strain across the growth plate, resulting in this area becoming inflamed and painful.
Children aged between 8 to 13 years of age can experience Sever?s disease with girls being normally younger and boys slightly older. Sever?s disease normally involves the back of the heel bone
becoming painful towards the end of intense or prolonged activity and can remain painful after the activity for a few hours. Severe cases can result in limping and pain that can even remain the next
morning after sport.
You may have pain when your doctor squeezes your heel bone. You may have pain when asked to stand or walk on your toes or on your heels. You may have pain in your heel when your doctor stretches your
calf muscles. Your doctor may order x-rays of the injured foot to show an active growth plate.
Non Surgical Treatment
Podiatrists have an important role in the provision of orthotics to young sufferers of Severs? disease. Orthotics are specialised insoles designed to accommodate problems with the foot. In this
particular condition?s case, orthotics are an effective way of making sure that the heel is cushioned in such a way as to reduce a child?s discomfort and alleviate some of the pressure of walking,
thereby facilitating the recovery process. Young athletes can benefit from a visit to a podiatrist to learn about prevention and to have orthotics fitted to prevent Severs? disease from developing.
Regular stretching to keep joints supple and loose are a great preventative measure, as is making sure that appropriately fitted and supportive shoes (often equipped with orthotics) are used to
prevent future injury.
It may take several weeks or months for the pain to completely stop. In most cases severs disease goes away on its own with a little rest and time. However if you ignore the pain and play through it,
the condition may get worse and may be more difficult to treat. When the pain is completely gone, you can slowly return to your previous level of activity. With future growth spurts the pain may
return therefore keep up with the stretches and follow the advice given.