Sever's Disease

What is it?

  • Sever's disease is heel pain in children. This pain is caused by inflammation (redness and swelling) of the heel growth plate. The growth plate is the area where the bone grows. It is located on the lower back part of the heel. In early puberty, bones often grow faster than muscles and tendons. This may cause the muscles and tendons to become very tight.

  • Sever's disease is more common in children who do regular sports or exercise that puts pressure on the heels. Activities such as running and jumping can put stress (force or pressure) on the tight muscles and tendons. This may lead to inflammation and heel pain. Sever's disease is most common in girls 8 to 10 years old and boys 10 to 12 years old. Children older than 15 rarely get Sever's disease because their heels have finished growing.

What causes Sever's disease?

  • Overuse or exercising too much. Your child's heel pain may be caused by repeated stress on his heels. This type of movement may occur when your child runs and jumps.

  • Pressure on the back of the heel from standing too much.

  • Wearing poor-fitting shoes. This includes shoes that do not support or provide enough padding for your child's feet.

What are the signs and symptoms of Sever's disease?

Your child may have pain along the edges of one or both heels during exercise. The pain usually goes away when resting, but may be worse in the morning. Your child's heel may also be slightly swollen and warm. The heel pain may be worse when your child stands on tiptoe. It may cause your child to limp when he walks. Your child's heel may hurt if the heel is squeezed on both sides toward the back.

How is Sever's disease diagnosed?

Your child's caregiver will examine your child's feet and heels. The caregivers may take x-rays, which are pictures of the inside of your child's foot. Sever's disease cannot be seen on an x-ray, but caregivers may use the x-ray to see if a broken bone is causing your child's pain. They may also see any damage to the heel growth plate.

What may be done to treat Sever's disease?

Sever's disease will usually heal within two weeks to two months. Following are some ways to help your child at home:

  • Help your child to rest his heel. Rest will decrease swelling, and keep the heel pain from getting worse. Your child may need to decrease his regular training or exercise. He may need to completely stop running and other activities that put pressure on the heel. Your child may need to stop these activities until his heel pain is gone. The caregiver may tell your child to do other kinds of exercise until the heel pain goes away. Your child may be able to swim or ride a bicycle while his heel gets better. These are exercises that do not put stress on the heel.

  • Put an ice bag on your child's heel and elevate the foot above the heart. Ice causes blood vessels to constrict (get small) which helps decrease inflammation. Put crushed ice in a plastic bag or use a bag of frozen corn or peas. Cover it with a towel. Put this under your child's heel for 15 to 25 minutes, three times a day. Do this for as long as you feel your child needs it. Do not let your child sleep on the ice pack because he can get frostbite. Raise the foot and prop it up so that it is lifted above the level of your child's heart. This will help decrease swelling.

  • Give your child medicine for pain. You may give your child ibuprofen (eye-bu-PROH-fen) or acetaminophen (a-seet-a-MIN-oh-fen) for his pain. These may be bought as over-the-counter (OTC) medicine. Read the medicine label or ask your child's caregiver how much medicine you should give your child. Do not give your child aspirin or any medicines with aspirin if he is less than 18 years old. Giving aspirin to your child when he is ill may cause a very serious illness called Reye's syndrome. Read medicine labels to see if your child's medicine has aspirin in it.

  • Encourage your child to do stretching and strengthening exercises.

    • Caregivers may teach your child exercises to stretch the hamstring and calf muscles and the tendons on the back of the leg. Other exercises will help strengthen the muscles on the front of the lower leg. Your child may be told to stop exercising if he feels any pain. Ask your child's caregiver when it is OK for your child to play sports. Your child should always do stretching exercises before sports activities. Stretching will loosen muscles and help decrease stress on the heel.

    • Make sure your child rests between activities. Teach your child to do cool-down and stretching exercises after heavy activities, such as running or soccer. Putting ice on the heel after activities may help keep your child from getting Sever's disease again.

  • Put shoe inserts inside your child's shoes. Caregivers may give you heel pads or cups for your child's shoes to decrease pressure on the heel bone. You may also be given special shoe inserts with firm arch support and a heel lift. Make sure that your child wears good quality shoes with shock-absorbent (padded) soles. Do not let your child go barefoot.

  • Use an elastic wrap or compression stocking. You caregiver may want you to use a special wrap or stocking to help decrease swelling and pain.

  • Your child may need to wear a cast. Your child's caregiver may also suggest putting a short-leg walking cast on your child. This may decrease your child's pain, and and help with healing by resting the tendon and bone. Your child may need to wear the cast for two to six weeks.

  • If your child can run or do other sports without too much pain, he may do them. After the Sever's disease is healed, your child should be able to go back to his usual activities.

Call your child's caregiver if:

  • Your child's pain or swelling increase.

  • Your child has new symptoms such as changes in skin color.

  • Your child has a fever.

  • Your child still has pain, even after finishing his treatment.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.