disease (sometimes called Sever disease) is a common cause of heel pain,
particularly in the young and physically active. It usually develops just
before puberty. Boys are slightly more prone to this condition than girls.
Physiotherapy can help manage the symptoms of Sever’s
disease so that the young person can continue to take part in physical
activity. Another name for Sever’s disease is calcaneal apophysitis.
Cause of Sever’s disease
A big tendon
called the Achilles tendon joins the calf muscle at the back of the leg to the
heel. Sever’s disease is thought to occur because of a mismatch in growth of
the calf bones to the calf muscle and Achilles tendon.
bones grow faster than the muscles, the Achilles tendon that attaches the
muscle to the heel gets tight. At the same time, until the cartilage of the
calcaneum is ossified (turned into bone), it is a potential weak spot. The
tight calf muscle and Achilles tendon cause a traction injury on this weak
spot, resulting in inflammation and pain.
disease most commonly affects boys aged ten to 12 years and girls aged nine to
11 years, when growth spurts are beginning. Sever’s disease heals itself with
time, so it is known as ‘self-limiting’.
is no evidence to suggest that Sever’s disease causes any long-term problems or
Symptoms of Sever’s disease
signs and symptoms point to Sever’s disease, which may affect one or both
heels. These include:
- Pain at the heel or around the Achilles
- Heel pain during physical exercise,
especially activities that require running or jumping
- Worsening of pain after exercise
- A tender swelling or bulge on the heel that
is sore to touch
- Calf muscle stiffness first thing in the morning
- A tendency to tiptoe
Factors that contribute to Sever’s disease
from age, other factors that may contribute to developing Sever’s disease
- Physical activity –
any form of exercise that is weight bearing through the legs or stresses the
soft tissue can exacerbate the pain of the disease.
- External factors –
for example, running on hard surfaces or wearing inappropriate shoes during
- Overuse injury –
very active children may repeatedly but subtly injure the bones, muscles and
tendons of their feet and ankles. In time, the accumulated injuries cause
Diagnosis of Sever’s disease
doctor or other health professional such as a physiotherapist can diagnose
Sever’s disease by asking the young person to describe their symptoms and by
conducting a physical examination. In some instances, an x-ray may be necessary
to rule out other causes of heel pain, such as heel fractures. Sever’s disease
does not show on an x-ray because the damage is in the cartilage.
Treatment of Sever’s disease
depends on the severity of the condition, but may include:
- Relative rest and modified activity –
a physiotherapist can help work out what, and how much, activity to undertake.
- Cold packs – apply ice or cold
packs to the back of the heels for around 15 minutes after any physical
activity, including walking.
- Shoe inserts –
small heel inserts worn inside the shoes can take some of the traction pressure
off the Achilles tendons. This will only be required in the short term.
- Medication – pain-relieving
medication may help in extreme cases, but should always be combined with other
treatment and following consultation with your doctor). Anti-inflammatory
creams are also an effective management tool.
- Splinting or casting –
in severe cases, it may be necessary to immobilise the lower leg using a splint
or cast, but this is rare.
- Time – generally the pain will ease in one
to two weeks, although there may be flare-ups from time to time.
- Correction of any biomechanical issues –
a physiotherapist can identify and discuss any biomechanical issues that may
cause or worsen the condition.
- Education on how to self-manage the
symptoms and flare-ups of Sever’s disease is an essential part of the
Other causes of heel pain
of heel pain other than Sever’s disease include:
- Plantar fasciitis –
inflammation of the ligament that runs from the heel bone along the sole of the
foot. Causes include flat feet and stiff shoes.
- Bursitis – bursae are small
sacs that contain fluid to lubricate moving parts such as joints and muscles.
Common causes of bursitis at the back of the heel include injury, overuse and
- Achilles tendonitis –
the Achilles tendon joins the calf muscle to the heel. Inflammation of this
tendon can be caused by stiff calf muscles and running on hard surfaces like
concrete or bitumen.
- Stress fracture –
results when the body’s inability to respond to loading on the bone leads to
weakening of the bone.
Where to get help
- A Physiotherapist
- Australian Physiotherapy Association Tel.
(03) 9092 0888
- A Podiatrist or Orthotist
- Your doctor
Things to remember
- Sever’s disease is a common cause of heel
pain, particularly in the young and physically active.
- Just before puberty the calf bones typically
grow faster than the surrounding soft tissue, which means the Achilles tendon
is pulled uncomfortably tight. This can lead to an injured heel.
- Treatment includes relative rest, modifying
activities and teaching the young person how to manage the condition when a
- Sever’s disease is self-limiting and rarely
causes long-term problems.
Feel free to ring Pivotal Motion Physiotherapy on 07 3352 5116 to discuss your podiatry options
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