Sever’s disease (calcaneal apophysitis) is the most common cause of heel pain in children, usually between the ages of 7 and 12 years old. Despite its name, it does not mean that the structures involved will break down or become severed. It is an inflammation of the growth plate occurs as a result of overuse, making it more common in children who are physically active.
During development, an area called the growth plate (epiphyseal plate) is responsible for the growth of bones. Growth plates are made of cartilage and are located at the ends of bones. When the bone reaches maturity, the growth plate closes and is replaced with solid bone. In the heel, this occurs at approximately 12 years of age. This means that, until then, the heel is not as strong and susceptible to stress.
Sever’s disease affects the growth plate at the back of the heel where the Achilles tendon inserts, connecting the calf muscle to the heel bone. Repetitive motions such as running and jumping stresses the growth plate, causing pain and inflammation. Tight calf muscles may exacerbate the condition.
It is important to note that not all active children develop Sever’s disease; those who do usually have a pre-existing biomechanical anomaly, such as excessive pronation (see image below).
Sever’s disease was first described in 1912 by an American doctor, James Warren Sever.
Signs and Symptoms
- Pain or tenderness around the heel
- Pain midway through or after activity
- Early morning pain
- Walking on toes or limping