Sever’s disease (or calcaneal apophysitis), named for its discoverer, James Warren Sever, is the most common cause of heel pain in children and usually occurs between the ages of 7 and 12 years old. Despite its name, it does not mean that the structures involved will break down or become severed. It is an inflammation of the growth plate which occurs as a result of overuse, making it more common in children who are physically active.
Its symptoms include pain or tenderness around the heel, pain midway through or after activity and early morning pain. Young children may be seen walking on their toes or limping to try and alleviate their pain, as well.
Sever’s disease is caused by stress to the growth plates or epiphyseal plates, which are cartilage-based structures located at the ends of bones in young children. These softer structures are only replaced with mature, solid bone when the child turns approximately 12 years old, which means that in the meantime their heels are susceptible to stress.
It affects the growth plate at the back of the heel where the Achilles tendon inserts, connecting the calf muscle to the heel bone. Repetitive motions such as running and jumping stress the growth plate, causing pain and inflammation. Tight calf muscles may exacerbate the condition.
It is important to note that not all active children develop Sever’s disease; those who do usually have a pre-existing biomechanical anomaly, such as excessive pronation (see above).
The heel pain can quickly grow to be unbearable for a child and symptoms will worsen if they don’t get enough rest or seek treatment early, depending on the severity of their condition, and what caused it. While it usually goes away with time and rest, if it is caused by an anatomical issue with your child’s feet, you may have to seek professional treatment. This might involve physiotherapy, or providing the child with shoe inserts to help support their heels.