Back to school season—and back to fall sports—brings lots of children into our podiatry practice in Massapequa, complaining of heel pain. But why can fall sports lead to heel pain in kids? The answer lies in a lesser-known condition called Sever’s disease.  

Sever’s Disease: a Common Cause of Heel Pain in Kids who are Active

When we see adults with heel pain, the diagnosis typically ends up being plantar fasciitis. And that condition is characterized by inflammation in your plantar fascia. (That’s the band of connective tissue running along the bottom of your foot, that starts at your heel).

But heel pain in kids is just different. In fact, with younger patients, heel pain is often due to something called calcaneal apophysitis, or Sever’s disease,  a condition characterized by inflammation in your child’s growth plate. (That’s located in the heel, near where the foot and Achilles tendon attach.)

Now, while the word ‘disease’ sounds frightening, the condition is not actually a disease—after all, it’s not contagious—but it is very common in active children. Especially ones who, like our 2023 Little League World Series Massapequa International Little League stars—have to play their sports while wearing cleats. (P.S. We are so proud of our Massapequa International 12 and Under Girls Team. Check out more about theire victory here!) But why does getting active, or wearing cleats, lead to heel pain in children?

Here’s the story. Sever’s disease usually develops when kids start a growth spurt, or are about to enter puberty. For young women, that means the risk of this heel pain is highest between ages 8 to 13; with young men, the risk is greatest between the ages of 10 and 15.  
Basically, when kids grow rapidly, the bones in their heels could expand at a faster rate that the tendons and muscles in their legs. Should that occur, the muscles may tighten up, reducing flexibility in the heels. In turn, that rigid heel will put excess pressure on the growth plates. Then, if your child is involved in school or club sports such as soccer, for which they need to wear cleats, heel pain could become a big problem. Here, wearing thin-soled, rigid athletic shoes puts extra stress on your child’s already stressed out growth plate.  As a result, it could sustain damage that leads to noticeable symptoms such as pain, tenderness and swelling near the site of that growth plate.

Identifying Sever’s Disease Symptoms Girls on the soccer field wearing cleats increase risk for Sever's disease

When it comes to diagnosing foot or heel pain in children, we sometimes face the challenge of pinpointing their symptoms, since kids aren’t always great at explaining the exact source of their discomfort. However, with Sever’s disease, our first diagnostic clue will be complaints of heel pain, especially when they come during or after athletic play.

Other symptoms of this condition include walking with a mild limp, or complaints of dull pain just behind the child’s heel. Unfortunately, because of the sometimes mild symptoms—and the time of onset for this condition—many parents and doctors think that early Sever’s disease symptoms are merely signs of growing pains. As such, they assure parents that the child will simply grow out of the heel pain, and suggest doing nothing to relieve the current discomfort. However, while Sever’s disease can resolve on its own, once the child’s growth plate closes, that process could take years. And, throughout that entire time, your child could be in serious pain.  So, if you want to avoid that outcome—and let your child stay active, involved in sports, and free of heel pain, you’ll have to seek treatment for Sever’s disease at our Nassau County podiatry practice.

Diagnosing and Treating Sever’s Disease in Children

In order to diagnose Sever’s disease as the cause of your child’s heel pain, we’ll have to take an oral history as well as an x-ray. After all, when viewing damage to the growth plate on a x-ray, it’s tough to tell whether it was caused by a fracture or by Sever’s disease.

Once we’ve gotten the right diagnosis for heel pain, we’ll get to work helping your child recover from calcaneal apophysitis. The first part of treatment will focus on loosening up the tight tendons and muscles that irritated the growth plate. To that end, your child will need to stretch and ice his or her feet and legs on a regular schedule. Fairly quickly, this should help pain improve. But, to bridge the gap while waiting for this plan to take effect, we can also manage pain with anti-inflammatory medications that will also reduce inflammation.

Additionally, your child may need an ankle brace for extra support, and to take pressure off the growth plate so inflammation can resolve and the area can heal.  As soon as your child’s pain levels improve, we’ll also start taking measures to prevent Sever’s disease from recurring. For some children, that will involve something simple like switching up their athletic foot gear to provide superior support during play. But, for other children, getting fitted for custom orthotics will be crucial to keep this heel pain from coming back. And that’s because, in some cases, the very structure of your child’s foot is part of the problem, putting constant pressure on his or her heel, with every single step.

In short, it’s important to remember that kids don’t have to wait and outgrow their heel pain. Simple interventions can quickly relieve the pain of Sever’s disease. And, while each treatment plan we suggest will be uniquely adapted to your child’s needs, it will work to resolve that heel pain, and keep it from returning.
Now, while you could avoid an office visit and wait around until your child’s Sever’s disease resolved on its own, that decision could mean letting your child walk around in pain, well into her or his teenage years. Clearly, that’s not an idea situation. Instead, we encourage you to schedule an appointment with our podiatrists in Massapequa. When you come into the office, we’ll start treating Sever’s disease, so that your child’s existing pain will improve, while you also reduce the risk of future pain or additional foot and ankle complications.

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