Introduction
Sever's disease is a condition that causes slowly growing pain and swelling in the growth plate in the heel of the foot.
Growth plates help bones grow into the length and width they will be when your child becomes an adult. They are strong but flexible discs of tissue called cartilage, usually found at the ends of bones. Growth plates are weaker than bone, so they are more at risk of injury as your child grows.
In Sever's disease, the muscles and tendons in the heel can become tight and pull on the growth plate as it slowly grows into adult bone. This causes swelling and pain.
Sever's disease is common in children between the ages of 9 and 13 who are going through puberty and growth spurts. It is even more common in children who play sports or do activities that involve:
- back and forth movements in the heel
- running
- jumping
- standing.
Common sports that can trigger sever's disease include:
- soccer
- rugby (leave, AFL, and union)
- hockey
- basketball
- netball
- tennis
- ballet.
Sever's disease will not happen again after the growth plate has finished growing.
Signs and symptoms
Symptoms of Sever's disease can happen in one or both heels and generally include:
- pain that slowly gets worse over time rather than starting suddenly
- pain that gets worse when there is pressure on the heel
- swelling and redness
- stiffness in the feet
- limping or other changes to how your child walks.
See your local doctor or physiotherapist as soon as possible if your child starts to develop pain or discomfort during sports and activities, even if it is mild.
Diagnosis
Your child's local doctor or physiotherapist will do a physical check if they think there could be Sever's disease. They might ask your child to gently move their heel to see where and how severe the pain is. They will also ask about your child's sports and activities and how regularly they do them.
Scans like X-rays are not needed unless your child's doctor thinks there is another cause of the pain.
Treatment
Treatment for Sever's disease will depend on how severe the pain is.
Your child's doctor may recommend:
- taking a break from activities that involve running and jumping until the symptoms get better
- putting an ice-back on the heel for 20 minutes after activity or walking that causes pain to flare up
- using a gel insert or heel raise in your child's shoes to reduce the strain
- seeing a physiotherapist to strengthen the muscles and tendons in the legs and thighs
- checking your child's movement and pain when they go through growth spurts.
Speak to your child's doctor about medications to help with pain or swelling.
With good rest and treatment, your child's pain should slowly go away.
Management
Returning to sports and activity
Your child should be able to slowly return to sports and activity when symptoms get better.
If your child's symptoms are more severe, they may need to take a break for 1-2 seasons of sport to help with recovery.
Speak to your child's doctor or physiotherapist if you are unsure or if your child needs to modify any movements to reduce pain.
Speak to your child's school, coaches, or other activity coordinators to make sure there is a plan in place to help your child have a safe and pain-free return to their activities.
Sever's disease and other conditions
Some children will have other issues with the structure of their foot that can make Sever's disease more likely to happen. There are also a number of conditions that can be confused with Sever's disease.
These can include:
- flat feet – where the bones and tissue in the arch of the foot touch the ground
- stress fractures – when a small crack or break happens in the bone after repeated stress or strain
- achilles tendonitis – when there is pain and swelling in the thick tendon at the back of the ankle caused by tears or breaks
- juvenile rheumatoid arthritis – a condition where the immune system attacks healthy tissue in the body, causing swelling and stiffness in the joints
- bursitis – swelling or inflammation of small, fluid-filled sacs that help reduce friction in body parts that move, like the joints.
Your child's doctor and physiotherapist will check for other conditions before diagnosing Sever's disease and may recommend other treatments.
See your local doctor if your child's pain does not improve after treatment.
Preventing Sever's disease
Sever's disease can start very slowly, so setting your child up with good habits is important to prevent the condition.
Good habits for sports and activities include:
- taking regular breaks and stopping as soon as there is pain
- stretching regularly
- warming up before the activity
- cooling down after the activity
- wearing shoes that fit well and have good support
- using special shoe inserts
- taking time to learn proper techniques for sports that involve jumping, running and impact on the feet.