Read all about it!

The latest Shawe Physio news & Healthcare science

Growing Pains Part 1 – Heel Pain – Sever’s Disease

By: | Tags: | Comments: 0 | August 11th, 2021

Children between the ages of 8 and 14 are at risk of developing Sever’s disease – a painful heel condition that is caused by a difference in the rate of growth between bones, tendons and muscles. Levels of loading through sports and activities is also a contributing factor to this issue as the Achilles tendon attachment is very close to the growth plate (end of the bone where growth takes place) of the heel.

Symptoms of Sever’s Disease, include the following, although not all may be present:

  • Pain in the heel during activity, especially running and jumping that goes away with rest
  • Stiffness in the heel when getting up in the morning
  • Limping
  • Walking on toes to avoid pressure onto the heel
  • Pain when squeezing the heel or wearing shoes shich compress the heel

Sever’s disease is most often present in both heels as sporting loads are often relatively equal through both, however, it is possible for it to occur in just one heel, dependent on previous injury history or sporting activities e.g. in the main jumping leg of a long jumper.

Sever’s disease usually settles within a couple of months if activity/loading of the Achilles tendon is managed correctly and although there may be recurrences if a return to activity is not taken steadily and monitored throughout. The condition itself is usually self-limiting to when growth has stopped, usually at around 14 years old for girls and 16 for boys. However, the boney deformity left after growth can cause issues with shoe comfort, as well as blisters.

This condition is often misdiagnosed as Hagland’s deformity or Calcaneal bursitis, it is therefore important to have adolescent heel pain assessed by an experienced medical professional to ensure the correct treatment pathway.

Things you can do to speed up recovery:

  • Stopping or limiting the activity causing the pain until pain resolves
  • Taking over-the-counter anti-inflammatory medication (check with your pharmacist first)
  • Wearing comfortable and supportive shoes which do not apply too much pressure to the heel region
  • Wearing boots that limit ankle movement, e.g. semi-rigid walking boots
  • Wearing gel cups under the heel to reduce impact
  • When pain is intense, try using an ice pack over a damp towel every hour for 15 minutes
  • Using elastic bandage over the ankle if there is swelling
  • Losing weight if overweight, to reduce day-to-day body weight loading through the Achilles tendon
  • Doing gentle stretches (see below)

Gentle stretches

The following stretches can help alleviate tension on the heel region which can reduce the growth plate disruption during activities.

Position yourself standing with one leg in front of the other and your hands resting on a wall. Lunge forwards while keeping your back leg straight. Ensure that both feet point forwards and your back heel remains on the ground to feel the stretch through the rear calf. Hold for 30 seconds, repeat 10 – 30 times a day as tenderness allows.

Position yourself standing with one leg in front of the other and your hands resting on a wall. Keep both of your knees bent. Ensure that both feet point forwards and your back heel remains on the ground. Hold for 30 seconds, repeat 10 – 30 times a day as tenderness allows.

Closing thoughts

If, after several weeks of rest and stretches, the pain does not improve or gets worse, we highly recommend an assessment by a qualified physiotherapist. At Shawe Physio we can fully assess the ankle to ensure that it is indeed Sever’s disease that is causing the pain. After the assessment, we can provide a bespoke package of treatment methods to offload the strain through the Achilles tendon into the heel bone such as:

  • Taping
  • Soft tissue massage
  • Assessment of the movement patterns in day-to-day and sporting activities
  • Testing for any muscle strength imbalances which may cause overloading of the calf muscles

These treatment methods are often the best way to get your child back to enjoying their sporting activities safely and with a reduced risk of reoccurrence or worsening of their symptoms.

If your child has a temperature as well as severe swelling and inflammation around the heel or the pain does not go away with rest, seek the advice of your GP.