As children reach their growth spurt in early puberty, the heel is one of the first body parts to grow to full size. Because children's bones are growing so fast, the muscles or tendons can't keep up and often become tight. The tight heel tendons can put a lot of stress on the heel, more so if a child is involved in sports or other weight-bearing activity. Over time, too much pressure on the heel can injure it and result in Sever's disease, also called calcaneal apophysitis.
Facts about Sever's disease
Children are at greatest risk of Sever's disease when they have reached the early part of a growth spurt in early puberty. For girls, this is around ages 8 to 10. For boys, it happens somewhere between the ages of 10 to 12. By the age of 15, the back of the heel has stopped growing in most children, and Sever's disease becomes rare.
Any running or jumping activities can increase the odds that a child will get Sever's disease. Soccer and gymnastics are common sports that tend to put kids at risk.
Symptoms of Sever's disease
If your child has any of these symptoms, call your healthcare provider for an evaluation:
Heel pain that starts after starting a new sport
Walking with a limp or on tiptoes
Pain that increases with running or jumping
Heel tendon that feels tight
Pain when you squeeze the child's heel near the back
Pain in 1 or both heels
It is not hard for a doctor to diagnose Sever's disease in a child or teen. A personal history and a physical exam are usually all it takes to find the cause of heel pain.
If your child is diagnosed with Sever's disease, treatment is straightforward. He or she should avoid any activities that cause a flare-up of heel pain. Treat the pain with ice for 20 minutes, 3 times a day. If the pain is severe, use over-the-counter pain relievers such as acetaminophen or ibuprofen for a short period of time. Don't use aspirin in a child or teen because it can result in a rare but life-threatening condition called Reye's syndrome.
In some instances, a child might have other foot problems, as well, such as high arches, flat feet, or bowed legs. In these cases, your doctor can recommend an orthotic device to help further prevent the pain related to Sever's disease. One other simple tip that can prevent Sever's disease or speed along recovery is for your child to wear supportive shoes and avoid going barefoot as much as possible.
Prevention and recovery
Properly stretching to maintain flexibility helps prevent Sever's disease. Try stretches for the calves, heel cords, and hamstrings. Your child should stretch 2 or 3 times a day, holding the stretch for about 20 seconds each time. Ask your child's doctor for specific exercise instructions. Generally, doctors advise stretching both legs, even if the pain is only in one heel.
It's also helpful to strengthen the shin muscles by having your child pull his toes in with a rubber exercise band or a piece of tubing and then stretch them forward. Help your child do this exercise15 times, 3 times a day.
Have your child wear shoes with good shock absorbers. He or she should also avoid running on hard surfaces as much as possible.