Latest News and Information

Everything you need to stay up to date with Athletic PT news and physical therapy resources.

Heel Pain in Kids or Sever’s disease – What you need to know

Join us in celebrating a groundbreaking collaboration in the world of physical therapy! Dr. Stephen Clark, DPT, owner of Athletic Physical Therapy, is thrilled to introduce Solemaids to young athletes in the United States, marking the first American venture into this innovative approach

What are #Solemaids, you ask? These revolutionary inserts have already made a significant impact in Denmark, helping over 10,000 young athletes aged 8-15 overcome the debilitating heel pain associated with Sever’s disease. Now, with Dr. Clark’s expertise and dedication, this transformative solution is making its way to the U.S., offering hope and relief to countless young athletes nationwide.

Solemaids are not just any ordinary inserts – they are carefully crafted to address the specific needs of youth and adolescent athletes, providing unparalleled support and comfort during sports activities. From soccer and football to lacrosse and gymnastics, Solemaids empower young athletes to pursue their passions with confidence and joy, free from the limitations of heel pain.

Dr. Stephen Clark’s commitment to bringing innovative solutions to his patients by offering inserts for heel pain and Sever’s disease both in person and online. Contact him at #stopmykidsheelpain

Sever’s disease – The Basics

  • Prevalence: Posterior heel pain is noted as the most common musculoskeletal complaint in the pediatric population. This is particularly true for active children aged between 8 and 15 years.
  • Sever’s Disease Incidence: The condition Sever’s disease, or calcaneal apophysitis, was first described by James Warren Sever in 1912. The reported incidence is mentioned as 3.7 per 1000 patients.
  • Nature of Sever’s Disease: Sever’s disease is characterized as an overuse injury with an insidious onset of pain, meaning it develops gradually over time and is not typically linked to a specific traumatic event.
  • Calcaneal Inflammation: The condition is associated with inflammation in the calcaneus (heel bone) in physically active growing children.
  • Presentation and Etiologies: The presentation of Sever’s disease can vary from case to case, and the causes can be multifactorial. However, there is an established association with physical activity and weight-bearing.

Understanding the prevalence, nature, and risk factors associated with Sever’s disease is crucial for healthcare professionals, parents, and caregivers. Recognizing the symptoms early on and implementing appropriate interventions, such as rest, stretching, and proper footwear, can contribute to effective management and a favorable outcome for children affected by this condition.

What is Sever’s disease?

Sever’s disease, also known as calcaneal apophysitis, is a common condition affecting children, especially those who are physically active during periods of rapid growth. The information you provided accurately describes the condition. Here is a breakdown:

  • Cause: Repetitive stress on the growth plate at the heel bone, specifically where the Achilles tendon attaches to the back of the heel.
  • Growth Plates: All growing children have growth plates, which are soft areas of cartilage where bone growth occurs. In Sever’s disease, the growth plate in the heel is affected.
  • Achilles Tendon and Muscle Growth: The Achilles tendon connects the calf muscles to the growth plate in the back of the heel. As bones often grow faster than muscles, especially in the foot, the Achilles tendon can become tight during certain stages of a child’s physical development.
  • Activities Leading to Sever’s Disease: Running and jumping, particularly in sports that involve these activities on hard surfaces (e.g., track, basketball, gymnastics), can contribute to Sever’s disease. Overtraining and inappropriate footwear that doesn’t adequately support the child’s feet may also be factors.
  • Mechanism of Injury: The already tight Achilles tendon pulls on the growth plate during activities like running and jumping, leading to irritation of the heel bone growth plate. This irritation causes pain and inflammation in the heel.

Parents and caregivers should be aware of the signs and symptoms of Sever’s disease, such as heel pain, limping, and difficulty participating in physical activities.

It’s essential to address the contributing factors, such as choosing well-fitted and supportive footwear, ensuring adequate rest and recovery, and adjusting activity levels to prevent recurrence.

Who Gets Sever’s disease?

Sever’s disease primarily affects children during their adolescent growth spurts. Here are some key points regarding the demographic most susceptible to Sever’s disease:

  • Age Group: It is most common in children during their growth spurts. In girls, growth spurts typically occur between the ages of 8 and 13, while boys usually experience growth spurts between 10 and 15 years old.
  • Rare in Older Teens: Sever’s disease is rare in older teens. As children enter late adolescence, their growth plates solidify into solid bone, and the muscles and tendons lengthen to match the bone growth. This reduces the susceptibility to the condition.
  • High-Impact Sports: Athletes who engage in high-impact sports, such as running and jumping, are at a higher risk of developing Sever’s disease. The repetitive stress on the growth plate, especially during activities like track, basketball, and gymnastics, can contribute to the condition.
  • Risk for Less Active Kids: While more common in active children, Sever’s disease can also affect less active kids. The relationship between tight Achilles tendons and bone growth can be a factor even in those who are not engaged in high-impact sports.

It’s important for parents, coaches, and healthcare providers to be aware of the risk factors and symptoms of Sever’s disease, especially in children going through growth spurts or participating in activities that involve repetitive stress on the heel. Early recognition and appropriate management can help alleviate symptoms and prevent long-term issues.

What are the symptoms of Sever’s disease?

The symptoms of Sever’s disease are primarily related to pain and discomfort in the heel area. Here is a summary of the common symptoms:

  • Heel Pain: The most prevalent symptom is pain or tenderness in the back of one or both heels. The pain typically focuses on the back of the heel, but it may also extend to the sides and bottom of the heel.
  • Limping: Children with Sever’s disease may exhibit a noticeable limp, especially after engaging in activities like running.
  • Swelling and Redness: Swelling and redness can occur around the heel area. This is a result of irritation and inflammation in the growth plate.
  • Foot Discomfort or Stiffness: Children may experience discomfort or stiffness in the foot, particularly after periods of inactivity, such as sleeping.

How is Sever’s disease diagnosed?

To diagnose Sever’s disease, a healthcare professional, typically a pediatrician or an orthopedic specialist, will perform the following:

  • Symptom Assessment: The doctor will gather information about your child’s symptoms, including when the pain started, the nature of the pain, and any activities that exacerbate or alleviate the symptoms.
  • Physical Examination: The foot will be physically examined, with the doctor palpating and squeezing different points to identify areas of tenderness and pain.
  • Imaging Tests: While not always necessary, an X-ray may be ordered to rule out other potential issues, such as fractures. Sever’s disease does not usually show up on X-rays, but the images can help exclude other possible causes of heel pain.

The combination of a thorough clinical assessment, a physical examination, and, if needed, imaging tests helps in diagnosing Sever’s disease and ruling out other conditions with similar symptoms. Early diagnosis and appropriate management are crucial for a successful recovery and to prevent the condition from worsening.

What is the squeeze test for Sever’s disease?

The squeeze test for Sever’s disease is a physical examination technique used by healthcare professionals to assess tenderness and pain in the heel area, specifically at the site where the Achilles tendon attaches to the back of the heel. This test helps in diagnosing Sever’s disease, a common cause of heel pain in growing children.

Here is how the squeeze test for Sever’s disease is typically performed:

  • Positioning: The child is usually asked to lie or sit comfortably, and the examiner will access the affected foot.
  • Squeezing the Sides of the Heel: The healthcare professional gently squeezes the sides of the heel, applying pressure on the area where the Achilles tendon inserts into the calcaneus (heel bone).
  • Observing for Pain Reaction: The examiner observes the child’s reaction to the pressure. If the child experiences pain or tenderness during the squeeze, especially at the back of the heel, it may indicate inflammation and irritation of the growth plate, characteristic of Sever’s disease.

This test is part of a comprehensive clinical examination, which also includes gathering information about the child’s symptoms, history of pain, and any activities that exacerbate or alleviate the symptoms. While the squeeze test can provide valuable information, it is often used in conjunction with other diagnostic measures, such as a physical examination and, in some cases, imaging studies like X-rays to rule out other potential causes of heel pain.

If Sever’s disease is suspected based on the clinical assessment, appropriate management strategies, including rest, stretching exercises, and modification of physical activities, may be recommended to alleviate symptoms and promote healing. More importantly, getting the correct inserts in insoles in a kid’s shoes and cleats are the best method for decreasing direct calcaneal heel forces. 

Do X-rays diagnose sever’s disease?

X-rays are generally not the primary method for diagnosing Sever’s disease (calcaneal apophysitis). Sever’s disease is primarily a clinical diagnosis, meaning it is based on the healthcare professional’s assessment of the child’s symptoms, physical examination findings, and medical history.

However, X-rays may be ordered in some cases, not to diagnose Sever’s disease itself, but to rule out other potential causes of heel pain. Sever’s disease primarily involves inflammation and irritation of the growth plate in the heel, which may not be clearly visible on X-rays because growth plates are made of cartilage and do not show up as well as bones on traditional X-rays.

The decision to order X-rays depends on the healthcare provider’s judgment and the specific circumstances. X-rays may help rule out other conditions such as fractures, infections, or structural abnormalities in the heel bone. The diagnosis of Sever’s disease is typically made based on clinical signs and symptoms, including heel pain, tenderness, and the results of a physical examination, such as the squeeze test.

Dr. Stephen Clark’s commitment to bringing innovative solutions to his patients by offering inserts for heel pain and Sever’s disease both in-person and online. Contact Dr Clark at #stopmykidsheelpain