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Sever’s disease

What is Sever’s disease?

Sever’s disease is a common cause of heel pain in children and young people. This condition is also referred to as ‘calcaneal apophysitis’.

The condition causes pain and discomfort in the heel where the tendon of the muscle attaches to the bone. There may be swelling on the heel that is painful to touch.

Sever’s disease happens when children’s bones grow faster than the muscles, tendons and ligaments. In the lower leg there are 2 bones: the tibia and the fibula. At the back of the lower leg the Achilles tendon joins the calf muscle to the heel. If the lower leg bones grow faster than the calf muscles, the Achilles tendon is placed under stress and tightens up, leading to pain and inflammation.

Symptoms are often made worse if the child has had a recent growth spurt. Symptoms may continue for several months.

Pain is usually felt during or after sport but in severe cases pain may be felt just walking around.

Who does it affect?

It usually affects:

  • Children between 8 and 12 years old
  • Children in a growth spurt
  • Children involved in sports, usually those that involve running and jumping

Signs and symptoms:

  • Pain at the back of the heel
  • More intense pain during or after running, jumping, sports activities
  • Tenderness (sometimes mild swelling or redness) at the back of the heel
  • Calf muscle tightness
  • The child may start to walk on their toes
  • Weakness in the calf muscle

How to help?

The pain associated with Sever’s disease may not go away completely whilst you are continuing to grow. These will help the symptoms:

Rest

Avoid sports that involve a lot of running or jumping. Limit sport to only what is comfortable. Stop any activity before you feel pain or reduce the time spent playing sport if you feel pain after stopping.

Ice cube massage

Ice the painful area for 10 to 15 minutes, especially after activity.

Pain relief

Pain relieving medication may reduce pain and swelling, but you need to discuss options with a pharmacist or GP.

Insoles

Sometimes shock absorbing insoles can help reduce the pain.

Calf stretches

Stand facing a wall with both knees and feet facing forward, with an arch in both feet, and both heels on the floor. With hands on wall lean forward and feel a stretch in the calves.

Illustration of someone facing wall and pushing themselves into it to stretch their calves

Hold for seconds

Repeat times

Facing a wall with both feet facing forward, keeping an arch in both feet. Squat down keeping knees over toes and both heels on the floor, as far as possible until you feel a deep stretch in both calves.

Illustration of someone facing wall and pushing themselves downwards to stretch their calves

Hold for seconds

Repeat times

Recovery

It may take several weeks or months for the pain to completely resolve. The problem may return with future growth spurts therefore continue with the advice given.

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Disclaimer

Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.

Resource number: PT11

Resource Type: Article

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United Kingdom

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