Sever’s disease is a common source of heel pain in growing children, adolescents, and teenagers[1].

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What is Sever’s?

Sever’s is a condition (or, injury) that occurs where the Achilles tendon (end of the calf muscle) attaches to the back of the heel bone. In the growing body, the tendon starts to pull at the back of the heel’s growth plate and causes pain and inflammation. It might affect one foot or, both. While Sever’s can last anywhere from months, to a year or more, it’s important to know that you do recover from it and that it usually doesn’t create longer term issues.

Who gets Sever’s?

Generally Sever’s is a condition seen during periods of growth, and usually amongst (though not always) children who are quite active (i.e. playing sports that require a lot of repetitive movements- running, bounding, jumping, hopping, etc).

What are some of the symptoms of Sever’s?

Children/adolescents will generally complain of pain around the heel of gradual onset. There is not usually one specific incident that happens. The child might typically find that pain and/or stiffness is worst upon getting out of bed in the morning and taking those first few steps. Similarly, this might be the same pattern of pain after sitting for extended periods of time (e.g. after class at school, doing homework, general sitting around at home). This generally shows a warming-up pattern and pain might improve/loosen with activity, only to come back after stopping. With worsening pain or severity, you might also notice your child limping and in more severe scenarios, the child might also find they are getting pain with physical activity as well (not just after).

Image is from ‘Complete Anatomy’
How might it be assessed by a health professional?

Physiotherapists, doctors, and podiatrists will all be well placed to detect Sever’s. The types of things they might do to confirm the presence of Sever’s is to palpate (touch) the heel where the Achilles inserts and this might be tender. There might also be some swelling. Other things that might be tested to confirm Sever’s can include pain on calf raise (going up onto the tip toes, and stretching the calf. Xrays are usually not necessary to diagnose this condition.

How might it be managed?

Sever’s doesn’t have a one size fits all model. Often the condition can also wax and wane until the growth years have stopped or stabilised. With that in mind, ‘management’ of symptoms is very important.

What sorts of things might be appropriate?:
  • Pain management (i.e. ice and/or analgesia)
  • Modifying load – this might mean revisiting training and activity schedules (load/volume/frequency) to find a better balance
  • Advice on footwear (type of shoes, orthotics, heel supports/wedges/pads, etc)[2]
  • Calf stretching to maintain flexibility (though we might not emphasise this during flare-ups as it can further irritate the tendon insertion into the heel)
  • Calf strengthening (i.e. calf raises onto tip toes) – again, as appropriate

Again, these conditions require a tailored approach. The information above is of a general nature and for informational purposes only (it does not constitute medical advice). Professional advice from your physiotherapist or health professional can assist to make informed decisions.

Dr Mark Merolli (PhD, Physiotherapist

 

Dr Merolli is one of our Physiotherapists. He has a keen interest in adolescent health. He has worked with several junior elite and recreational sporting organisations, including Tennis Australia’s junior program, Melbourne Victory youth squad, and various other Aussie rules, basketball, and soccer clubs. He regularly lectures and teaches to Victorian school students about sports medicine, and managing injuries from a young age.

[1] James, A.M., Williams, C.M. & Haines, T.P. Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever’s disease): a systematic review. J Foot Ankle Res 6, 16 (2013). https://doi.org/10.1186/1757-1146-6-16

 

[2] Perhamre, S., Janson, S., Norlin, R. and Klässbo, M. (2011), Sever’s injury: treatment with insoles provides effective pain relief. Scandinavian Journal of Medicine & Science in Sports, 21: 819-823. https://doi.org/10.1111/j.1600-0838.2010.01051.x