By Christine Minor, MSEd, ATC

Sever’s disease, or calcaneal apophysitis, is a common heel injury seen by athletic trainers working with youth and adolescent athletes. It is most often caused by overuse. Repetitive stress can cause inflammation at the growth plate in the heel. The onset of pain often coincides with a growth spurt when the child’s bones, muscles, and tendons are growing and changing rapidly. Sever’s disease is most commonly diagnosed between 8 and 12 years of age. It is more common in boys, and about 60 percent will have pain in both heels.

Treatment for Sever’s disease initially focuses on reducing pain. This usually requires modifying activity for a period of time. Treatment varies from lowering the frequency, duration, and intensity of athletic demands to full rest. Additional treatment can include stretching and strengthening exercises for the calf, Achilles tendon, and lower leg. For pain relief, your child may receive Dexamethasone during physical therapy through a process called iontophoresis, a method of getting the steroid more effectively across the skin barrier. Less pain allows the athlete to do more in rehabilitation. As pain diminishes, participation in sports can be resumed with careful monitoring.

Other treatments that may help lessen pain and discomfort include:

• Heel cups in shoes or cleats worn for sports and daily wear. These are soft inserts that lessen the stress on the heel by distributing it more evenly and providing a more cushioned surface for the heel to sit.
• Minimizing time spent in cleats, which are hard on the heels.
• Wearing shoes that slightly elevate the heel. This small elevation takes some of the pressure off the inflamed growth plate.
• Use of nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen or naproxen. These medications can help lessen pain and inflammation. To avoid masking pain, NSAIDs should never be taken prior to exercise.
• Ice application to the heel. This can also help decrease pain.
• In severe cases where walking is affected due to high pain levels, a physician may suggest using a walking boot.

Young athletes typically experience symptoms of Sever’s disease for two to three months, with some cases lasting longer. Symptoms may reoccur after the initial onset, especially if the athlete is experiencing a growth spurt or an increase or change to their athletic demands. It is also important that footwear provide appropriate support to the foot and heel. Footwear should be replaced at least every six months as it breaks down over time.

If your child has persistent heel pain, schedule a visit with one of CHKD’s sports medicine physicians by calling (757) 668-PLAY. Your child may also need follow-up treatment from a sports medicine physical therapist or certified athletic trainer.

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About CHKD Sports Medicine

CHKD's sports medicine program offers the most comprehensive care for your young athlete. From diagnosis and treatment to customized rehabilitation plans, we specialize in physical therapy and injury prevention programs for active children and teens. Our team is composed of pediatric orthopedic surgeons, sports medicine specialists, physician assistants, certified athletic trainers and pediatric sports medicine physical therapists.