Sever’s Disease

What Is Sever’s Disease?

Sever’s disease is a common cause of heel pain in growing kids, especially those who are physically active. It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids grow most rapidly. This growth spurt can begin any time between the ages of 8 and 13 for girls and 10 and 15 for boys. Sever’s disease rarely occurs in older teens because the back of the heel usually finishes growing by the age of 15, when the growth plate hardens and the growing bones fuse together into mature bone.

During the growth spurt of early puberty, the heel bone (also called the calcaneus) sometimes grows faster than the leg muscles and tendons. This can cause the muscles and tendons to become very tight and overstretched, making the heel less flexible and putting pressure on the growth plate. Over time, repeated stress (force or pressure) on the already tight Achilles tendon damages the growth plate, causing the swelling, tenderness, and pain of Sever’s disease.

Such stress commonly results from physical activities and sports that involve:

• Running
• Jumping
• Especially those that take place on hard surfaces, such as track, basketball, soccer, and gymnastics

Sever’s disease also can result from standing too long, which puts constant pressure on the heel. Poor-fitting shoes can contribute to the condition by not providing enough support or padding for the feet or by rubbing against the back of the heel.

Although Sever’s disease can occur in any child, these conditions increase the chances of it happening:

• Pronated foot (a foot that rolls in at the ankle when walking), which causes tightness and twisting of the Achilles tendon, thus increasing its pull on the heel growth plate
• Flat or high arch, which affects the angle of the heel within the foot, causing tightness and shortening of the Achilles tendon
• Short leg syndrome (one leg is shorter than the other), which causes the foot on the short leg to bend downward to reach the ground, pulling on the Achilles tendon
• Overweight or obesity, which puts weight-related pressure on the growth plate

The most obvious sign of Sever’s disease is pain or tenderness in one or both heels, usually at the back. The pain also might extend to the sides and bottom of the heel, ending near the arch of the foot.

A child also may have these related problems:

• Swelling and redness in the heel
• Difficulty walking
• Discomfort or stiffness in the feet upon awakening
• Discomfort when the heel is squeezed on both sides
• An unusual walk, such as walking with a limp or on tiptoes to avoid putting pressure on the heel

Symptoms are usually worse during or after activity and get better with rest.