Heel Pain in Children – Sever’s Disease

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Sever’s Disease – What Is It And What Can Be Done?
By Hannah Gamble (Sports Massage Therapist)

Despite sounding quite scary, Sever’s disease is a common heel injury that effects children between the ages of 8 and 15, most regularly seen between 9 severs in active childrenand 12/13. It usually occurs during a growth spurt in physically active/sporty children and can be very painful. Although it is often debilitating at the time, it is an issue that will have no long-term effects after growth has finished.
Hannah Gamble, Sports Massage Therapist, has seen an increase in the injury recently, so thought it was timely to talk about it. This may be due to the season; the increased level of activity during the summer term (running around at every opportunity), the hard summer ground, and perhaps an increase level of sport in general – children are being inspired to be more active.

What is Sever’s disease?Severs Disease
It is a painful injury caused by inflammation of the growth plate in the heel. As children grow, the heel bone can grow faster than the leg muscles and tendons. This causes the muscles and tendons (especially the Achilles tendon) to become overstretched and tight, making the ankle movement less flexible. This results in the tendons pulling on the heel growth plate as children walk/run. So, in active children, who are running and playing sports a lot, this repeated pulling on the heel will cause swelling and tenderness – Sever’s disease. Other causes can be from standing too long, putting constant pressure on the heel; over pronation of the feet (when foot rolls in during walking); flat or particularly high arch; and even poor fitting shoes can contribute. Despite being seen most frequently in active children, excess weight can contribute too, due to extra pressure on the growth plate.

Has my child got Sever’s disease?
The main symptom is tenderness or pain in one or both heels, which worsens during activity and reduces with rest. Other symptoms include, pain or stiffness in the heel/feet when getting up in the morning; pain during walking, increasing when running; walking on forefoot/toes to avoid putting the heel down; redness or slight swelling in the heel. If you are unsure, book in to see our physiotherapist or podiatrist who will assess and diagnose your child.

How do you treat Sever’s disease?
In the first instance, the main treatment is rest. This will relieve the pressure on the heel bone and allow the swelling and pain levels to reduce. All running, and impact sports should be avoided until the pain has decreased. Ice can be applied 2-3 times daily for the first few days/week (15 mins at a time) this will help reduce the swelling and pain. If your child is unable to avoid physical activity, ice and elevate the foot or feet afterwards – but be aware that if running/jumping based sports are not reduced, the recovery time will be significantly longer. With proper care, the condition can clear within a couple of weeks, but can take several months.

Alongside rest, we would advise massage treatment, which can certainly help. Soft tissue work into the calf muscles and Achilles tendon will increase blood and lymphatic flow, bringing oxygen and fresh blood to the area to aid recovery while removing waste. It will also help to release tightness and tension throughout the overworked and overstretched muscles, easing the pressure pulling on the heel. At this point, gentle stretching can be introduced, but your child should not overstretch the calf, as this will add to the tension at the heel. For examples of calf stretches, see our exercise page. These can be performed 2-3 times daily, holding the ‘gentle’ stretch of 30 seconds, once with a straight leg, once with a bend at the knee.

It would be a good idea to assess your child’s trainers. Quality, well-fitting and supportive shoes are needed if your child does a lot of sport, with good shock absorbing soles too. If your child has flat feet or rolls over as they walk/run, you should consider purchasing orthotic insoles, such as Scholl or Superfeet, but professionally made orthotics are better. Due to the rapid growth of children’s feet, our podiatrist usually provides pre-made insoles, which he adds support to, making them personal to your child’s foot shape.

How to prevent Sever’s Disease
It is very difficult to prevent Sever’s Disease, although the risk will simply reduce over time until growth is complete. But, having said that, encouraging your child to stretch regularly is important, especially if they are particularly sporty. Regular calf stretches could help your child avoid pain during their next growth spurt. Daily leg and glute stretches would be fantastic, but they should certainly get become accustomed to stretching after sport – this will go a long way to helping them in the future to avoid such issues as Achilles tendinopathy and runners knee. Equally, some regular self-massage into the calves, and the introduction of a foam roller (if your child very keen on competitive sport) is also advised.

If you are worried your child may be developing/have Sever’s disease, book in with Hannah for a sports massage to reduce pain/tightness in the calves or heels, or see Lawrence for bespoke insoles. Our physiotherapist will also advise on stretching and treat the issue.

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