Randa Idleburg
I'm not young enough to know everything.
Treating Calcaneal Apophysitis

Sever?s Disease is used to describe pain in the back of the heel that comes from an inflamed growth plate in your child?s heel. Sever?s Disease commonly occurs in children from the ages 8-15. The muscles and tendons become tight as the bones shift and grow. This causes pain when walking or participating in athletic events that require running and jumping.


Severs disease is often associated with a rapid growth spurt. As the bones get longer, the muscles and tendons become tighter as they cannot keep up with the bone growth. The point at which the achilles tendon attaches to the heel becomes inflamed and the bone starts to crumble (a lot like osgood schlatters disease of the knee). Tight calf muscles may contribute as the range of motion at the ankle is reduced resulting in more strain on the achilles tendon. Sever's disease is the second most common injury of this type which is known as an apophysitis.


Signs and symptoms of Sever?s disease include heel pain can be in one or both heels, and it can come and go over time. Many children walk or run with a limp, they may walk on their toes to avoid pressure on their heels. Heel pain may increase with running or jumping, wearing stiff, hard shoes (ex. soccer cleats, flip-flops) or walking barefoot. The pain may begin after increasing physical activity, such as trying a new sport or starting a new sports season.


A physical exam of the heel will show tenderness over the back of the heel but not in the Achilles tendon or plantar fascia. There may be tightness in the calf muscle, which contributes to tension on the heel. The tendons in the heel get stretched more in patients with flat feet. There is greater impact force on the heels of athletes with a high-arched, rigid foot. The doctor may order an x-ray because x-rays can confirm how mature the growth center is and if there are other sources of heel pain, such as a stress fracture or bone cyst. However, x-rays are not necessary to diagnose Sever?s disease, and it is not possible to make the diagnosis based on the x-ray alone.

Non Surgical Treatment

Home treatment consists of calf muscle stretching exercises, heel cushions in the shoes, and/or oral anti-inflammatory medications like Tylenol or Advil. Icing the area may provide some temporary relief. If the condition persists the child should be evaluated by a podiatrist for abnormal foot function. In severe cases a below the knee walking cast may be required. Treatment may require the use of custom-made shoe inserts called orthotics. Orthotics work by correcting foot function and will fit into most normal shoes and athletic cleats.

Surgical Treatment

The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.

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