Sever's Disease

​My kids play a lot of sport.  When they over-train they get heel pain.  Heel pain in kids is called Sever’s disease, or calcaneal apophysitis (which means inflammation of the growth plate of the heel bone - which is the calcaneus).

---

​HEEL PAIN IN CHILDREN

Sever’s is most common in 9 - 12 year olds.  It’s sore to squeeze the bone at the base of the Achilles where it attaches onto the heel.  It’s not something that can be seen - it never seems to look red or swollen.  It’s worse after sprinting, jumping, and hopping.  It settles with rest.  It is an overuse injury so it’s common in pre-season, or anytime training loads increase too quickly.  My kids get it when they do extra sessions in running spikes or footy boots, without the normal heel support of their running shoes.  It’s an overuse injury from excessive loads.
​

​OVERUSE INJURY

When we talk about excessive loads it can be “external” load such as:

• number of sessions
• length of sessions
• pace of running
• hills
• novel activity
• footware
• ground surface

I think the running pace is the more powerful multiplier in this list.  Extra sprint sessions will do it.  My kids got sore once when we did a boot-camp session with a novel plyometric exercise - split jumps.

There are also “internal” variables that determine our ability to cope with the training load:

• nutrition
• stress
• sleep
• growth spurts

My kids definitely are more prone to Sever’s if they’ve had a couple of late nights that week.  And, if they’re having a growth spurt, their bodies are busy spending resources on growing rather than recovering from the stress of a training session.
​

​NATURAL RECOVERY

Text books say that Sever’s disease is self-limiting because the growth plate eventually fuses by the age of 15 or 16.  But I don’t think there’s anyone who would be happy to just let it run its course until then.  It is usually sore enough to stop you participating in sport, so it needs treatment.
​

​WHAT DO WE DO?

I used to put kids with heel pain in orthotics, until I read this research which confirms that a simple heel wedge is more effective than orthotics for Sever’s disease.  Cheaper and easier.

I get them to do an isometric Achilles strengthening program which also helps with pain control.

But ultimately recovery comes down to load management.

Load management means reducing the excessive loads. So this could be:

• less sessions/week
• shorter sessions
• less sprint work
• run in joggers rather than spikes or footy boots
• less hills
• heel wedges in shoes
• stay in shoes - no bare feet / thongs / flats. I really like them to stay in some sort of shoe with a heel all the time. Even if they’re getting up to use the bathroom I want them to slip their joggers on.

And aid recovery with:

• plenty of sleep
• massage calf muscles
• ice and Ibuprofen for pain relief when sore

---

---

​HAVE YOU HAD A CHILD WITH SEVER’S DISEASE?