Severs Disease - a common cause of heel pain in children and adolescents

By Jack Redden, APA Physiotherapist

What is it?

Sever’s disease is an inflammatory condition to the calcaneal apophysitis, or the growth plate underneath the heel. It is a common cause of heel pain within adolescents. The condition occurs where the Achilles tendon attaches to the bone in the period when it is changing from cartilage to bone. Pain is caused when the Achilles tendon pulls at the attachment point or from repetitive impact of the heel hitting the ground, or both. Sever’s is managed conservatively with a variety of treatment options outlined below. 

Who get’s it?

This condition is common within the active adolescent population, usually starting in pre teens. Sever’s usually affects children aged 8-14 when growth spurts are beginning. Pain will often be felt during physical activity, in particular with running or jumping activities. Pain may also be worsened following strenuous exercise and in particular the morning following activity. 

What can physio do to help?

Management of Sever’s is often based around activity modification, limiting the painful activities to allow pain free movement. Your physio will then guide you in managing your load to sufficiently allow the inflammation to settle and then adequately load the tendon to allow a successful recovery. Soft tissue release can be effective in lengthening the muscles that attach to the Achilles tendon, further taking load off the apophysis. Your physio will then prescribe a home exercise program to further assist in your recovery, based off findings from the initial assessment and treatment. This program will be based around stretching or other methods to lengthen the calves, hamstrings and any other areas that may be tight and contributing to increased tension at the heel. A graduated strengthening program may also be required depending on the findings in their assessment. The use of heels lifts can also be effective in offloading the Achilles tendon and relieving the pressure on the apophysis. 

If you know someone suffering from any of the above, contact your Physiotherapist for the appropriate advice and management.