Spotting Sever’s Disease: Heel Pain in Growing Children

Inspired by a recent patient, Scarlett, we’ve decided to raise awareness about Sever’s disease, a condition that often goes undiagnosed but affects many young athletes and active children. When Scarlett came in with complaints of heel pain, we quickly recognized the signs of Sever’s disease—something that is frequently overlooked as a common ache from physical activity. While it’s normal for kids to feel some discomfort during physical activity, Sever’s disease (or calcaneal apophysitis) specifically targets the growth plate of the heel bone, causing significant pain, especially in active children and adolescents like Scarlett. 

In this blog post, we’ll dive into what Sever’s disease is, its causes, and the symptoms to watch for. We’ll also share how physical therapy played a crucial role in recovery, actionable tips on how parents can spot early signs of Sever’s disease, and proactive steps to prevent it in their active children. Plus, learn more about Scarlett’s story and how you can follow along on her road to recovery!

What is Sever’s Disease? 

Sever’s disease, also known as calcaneal apophysitis, is a common condition in children and adolescents that causes pain and inflammation in the heel. The condition specifically affects the growth plate (epiphyseal plate) of the heel bone. This area is where the bone is still growing, and it’s particularly vulnerable to injury due to the stress of physical activities. 

The condition is often confused with other growth plate injuries, such as Osgood-Schlatter disease, which affects the knee. However, while both involve inflammation at the site of a growth plate, they occur in different areas of the body and are triggered by different physical stresses. Osgood-Schlatter affects the tibial tuberosity just below the knee, while Sever’s disease affects the heel bone.   

The Importance of Correctly Diagnosing Sever’s Disease 

Bringing awareness to Sever’s disease is crucial because it is easily misdiagnosed as other conditions, leading to improper treatment and delays in recovery. The pain associated with Sever’s disease shares similarities with other common heel injuries like Achilles tendonitis or plantar fasciitis, which can result in treatments that don’t address the underlying issue. For example, prescribing tendon stretches for Achilles tendonitis would not relieve the stress on the growth plate in Sever’s disease. This could worsen the condition and prolong discomfort. 

Additionally, misdiagnosis may cause children to continue participating in sports or other high-impact activities without proper management, potentially causing further strain on the growth plate and increasing the risk of long-term complications. Without proper treatment, the imbalance in the lower leg muscles caused by Sever’s disease may persist, potentially leading to abnormal gait patterns, muscle imbalances, and even long-term discomfort. Awareness of the condition and its specific symptoms—such as pain that worsens with activity, localized heel tenderness, and swelling—ensures that young athletes receive the right diagnosis and treatment plan, helping them recover more quickly and safely return to their active lifestyles.

Causes and Risk Factors 

The Role of Growth Spurts 

Rapid growth during childhood can create imbalances in the body. As bones grow faster than muscles and tendons, tension on the heel increases, making the calcaneal growth plate more susceptible to inflammation. 

Foot Mechanics and Alignment Issues 

Flat feet or high arches can disrupt the normal mechanics of walking, running, and jumping. These irregularities add extra stress to the heel, contributing to the development of pain and inflammation.   

Increased Physical Activity 

A sudden spike in activity levels, overtraining, or engaging in high-impact sports without proper preparation can place excessive strain on the heel, triggering the onset of Sever’s disease. 

The Link Between Sports and Sever’s Disease Symptoms

High-impact activities like running, jumping, and sudden direction changes—common in sports like soccer, basketball, gymnastics, or dance—put repetitive stress on the heel, often triggering the symptoms of Sever’s disease. The continuous pounding and pressure from these activities cause inflammation in the calcaneal growth plate, irritating the surrounding tissue and leading to pain and swelling.

During growth spurts, the muscles and tendons in the lower leg may not stretch as quickly as the bones, increasing tension around the heel. This imbalance adds strain to the growth plate, making it more vulnerable to injury, especially with intense physical activity.

Treatment Options: How Physical Therapy Helps 

Physical therapy is one of the most effective ways to treat Sever’s disease, focusing on addressing the root causes of pain, improving flexibility and strength, and preventing future injuries. Below is how physical therapy helps manage and treat Sever’s disease: 

Stretching and Flexibility Exercises: Stretching the calf muscles, hamstrings, and plantar fascia helps alleviate tension on the Achilles tendon and the heel. Tight muscles are often a contributing factor to the pain in Sever’s disease, and these stretches can reduce discomfort while improving flexibility, allowing for smoother movement without additional strain on the heel. 

Strengthening Exercises: Physical therapists emphasize strengthening the calf muscles and Achilles tendon through exercises such as heel raises. Stronger muscles help absorb shock and reduce the stress placed on the heel, promoting better overall function. Strengthening also helps the child build muscle endurance to support the growing body, reducing the likelihood of future injuries. 

Biomechanical Corrections: A physical therapist will assess the child’s walking and running patterns to determine if any issues with biomechanics are contributing to the heel pain. They may recommend orthotics (custom insoles) or footwear modifications like arch supports or cushioned heel pads. These help correct alignment issues, distribute pressure more evenly, and reduce stress on the heel. 

Manual Therapy: Physical therapists may use hands-on techniques such as soft tissue mobilization and massage to release tight muscles and fascia. This manual therapy improves blood circulation in the affected area, relieves stiffness, and promotes healing, further reducing pain and discomfort associated with Sever’s disease. 

Gradual Return to Activity: Physical therapy includes a structured program to help your child return to their activities or sports gradually. Starting with low-impact exercises, like swimming or cycling, the intensity can be increased as the pain decreases and strength improves. This helps avoid re-injury and ensures that your child is ready to resume full physical activity without aggravating the condition. 

Education and Prevention: One of the most critical aspects of physical therapy for Sever’s disease is education. Physical therapists educate both parents and children on proper warm-up and cool-down techniques, the importance of stretching, and how to monitor activity levels. Understanding how to reduce the risk of overuse injuries through preventive measures can help ensure long-term recovery and avoid future flare-ups.

Parents’ Guide to Spotting Sever’s Disease 

Recognizing the early signs of Sever’s disease is crucial for preventing long-term issues and ensuring your child recovers effectively. Keep an eye out for these key indicators: 

• Consistent Heel Pain: If your child frequently complains of heel pain, especially after physical activity, this could be a sign of Sever’s disease. 
• Avoiding Activities: Notice if your child starts avoiding sports or activities they typically enjoy due to heel discomfort. 
• Swelling or Tenderness: Pay attention to any swelling or tenderness at the back or bottom of the heel, as this is a common symptom. 
• Difficulty Walking or Running: If your child starts limping or seems uncomfortable while walking or running, the pain may be coming from the heel. 

Catching these signs early can help prevent further damage and promote a faster, more effective recovery. 

Prevention Strategies 

Preventing Sever’s disease starts with educating parents and coaches on the importance of monitoring children’s activity levels and ensuring proper care of their growing bodies. Here are some key prevention strategies: 

Proper Warm-Up and Cool-Down Routines:

Encourage your child to always complete a warm-up and cool-down before and after physical activity. This prepares the muscles, tendons, and ligaments for movement and reduces the risk of injury. Stretching the calf muscles and Achilles tendon should be part of the warm-up. 

Choosing Appropriate Footwear:

Proper footwear that provides adequate arch support and cushioning is crucial for minimizing stress on the heel. Ensure your child’s shoes fit properly and are appropriate for the specific activity. 

Gradual Increase in Activity Levels:

Avoid sudden increases in intensity or frequency of physical activity. Gradually build up endurance and strength to avoid overuse injuries. Encourage rest periods and cross-training to avoid repetitive stress on the heels.

Follow Scarlett’s Journey 

Want to follow Scarlett’s recovery journey? Be sure to follow us on Instagram @breakthruptfitness, where we post weekly updates on her progress. We’re excited to share her story and the milestones she achieves as she gets back on track with her active lifestyle! 

Breakthru is Here to Help Your Child Get Back in the Game 

At Breakthru Physical Therapy + Fitness, we understand how important recovery is for your child to return to their activities. Our dedicated team is here to provide the care and support needed to heal from Sever’s disease and get your child back on the field. Whether it’s through hands-on physical therapy, personalized recovery plans, or educational resources for parents, we’re here to help every step of the way. 

Don’t wait to start your child’s recovery and schedule an appointment with us today — let our expert team help your child feel their best!