Children’s Heel Pain (Sever’s) Treatment in Winchester and Basingstoke

Sever’s Disease, otherwise known as Calcaneal Apophysitis, is the most common cause of heel pain in children. It’s also the most common ‘condition’ we see children presenting with at Eclipse Foot Clinic. Unfortunately, the name suggests that it’s ‘disease’, and that tends to scare children and their parents when they hear the diagnosis. It’s for this very reason, that we tend to use the term ‘Sever’s’ or ‘Calcaneal Apophysitis’, as it is a much more accurate description of what the pathology involves.

What is Sever’s Disease?

Sever’s Disease generally occurs in active children, between the ages of 9 – 14. It is caused by repetitive pulling of the achilles tendon (the large tendon behind your ankle) against the heel bone, known as the calcaneus. As with every other bone in the body, a child’s calcaneus has a growth plate, that is situated at the back of the bone. This allows the bone to grow appropriately during the developmental years. In active children that do a lot of running or jumping, the achilles tendon tightens and starts to pull excessively on the growth plate in the calcaneus. This starts to cause micro-damage to the growth plate and it gradually starts to become inflamed. Sever’s can be extremely painful and debilitating, however, it generally responds quickly to early treatment. Our Paediatric Specialist Lydia provides professional Sever’s children’s heel pain treatment.

What are the common symptoms of Sever’s?

Pain at the back of the heel, particularly during and/or after running or jumping
Some children experience pain underneath the heel, but the majority is around the sides and the back of the heel
Pain walking first thing in the morning, particularly after training or playing sport the night before. This often warms up as the child starts walking for 5-10 mins and can become pain free until they start running again
It is rare to see any swelling or bruising with Sever’s

How is Sever’s diagnosed and treated?

A thorough biomechanical assessment and detailed history will normally be enough to diagnose Sever’s. Depending on the severity of symptoms, Lydia may request an Ultrasound scan from our MSK Lead Podiatrist Edd to rule out any other issues, however this is rare.

Treatment options are largely tailored around addressing the individual risk factors. Given this, an initial consultation will involve a thorough foot and lower limb biomechanical assessment, to determine what your contributing factors are. As with most foot problems, it’s best to quickly implement heel pain treatment, to reduce the chances of it turning into a chronic condition.

Common Treatment Options Include:

Moderated rest: As Sever’s is an over-use injury, the most important first line treatment recommendation is reducing activity levels. This often starts with unnecessary activities such as running around on weekends or in the child’s lunch breaks at school. This is to try and keep them participating in their desired sport. Severe cases can result in the patient having to take a short amount of time off running to help allow the heel bone to settle down
Strapping/taping: This helps to reduce the tension of the Achilles tendon on the growth plate
Massage through the calf muscles: The looser the calf muscle is, the less tension there is in the Achilles tendon, and therefore the less pulling against the growth plate of the heel
Footwear modifications: We commonly place heel wedges in the back of the child’s shoes to help get their heel up off the ground and therefore reduce tension in the Achilles tendon
Soft, custom insoles: These help off-load the Achilles and reduce pulling against the heel as well as stopping the foot/ankle from rolling in (only used if biomechanically required)
Strengthening program: To address any underlying weakness and to progressively load the tendon
Moon boot: These are rarely used and are only required for chronic, painful cases that don’t respond to conservative treatment

How long will Sever’s take to get better?

Whilst Sever’s is a common condition, it should be treated as early and aggressively as possible. Symptoms often start quite mild, so parents hold off on getting treatment until their child starts limping. During this time, it can turn into a chronic condition, leading to a significant increase in recovery time. Fortunately, Sever’s tends to respond really well to the above conservative treatment options, assuming there is a high level of compliance from the child and parents. Eclipse Foot Clinic provides professional children’s heel pain (Sever’s) treatment in convenient locations. So, if your child is suffering from pain at the back of the heel, and its impacting on their sport, contact our clinic today and we will get them on the road to recovery.

Why did my child get Sever’s?

Whilst any child between the ages of 9 – 14 can develop Sever’s, there are some common risk factors that we have identified, that significantly increase the chances of suffering from heel pain. They include:

Over-activity: Sever’s is extremely common in children who are playing multiple sports during the week and on weekends. This is particularly true for sports that involve a lot of running/jumping such as basketball, football, netball etc.
Children with tight calf muscles: The tighter the calf muscles, the tighter the achilles tendon is and therefore, the more tension there is at the growth plate
Children who experience rapid growth spurts: This leads to tightening of the calf muscles and achilles tendon as per above
Poor quality footwear: The growing foot is vulnerable to injury, particularly if they aren’t supported by the appropriate footwear
Feet that roll in (pronate): When the foot and ankle rolls in, it leads to a bowing of the achilles tendon and therefore causes more pulling against the growth plate of the heel bone
Sudden increase in physical activity: Sever’s is extremely common September to October in the UK, as it is during the first couple of months for winter sports. If activity levels are suddenly increased, the achilles tendon and bone don’t have time to adapt and therefore get aggravated quickly
Sports involving hard surfaces. Hard surfaces leads to increase load being placed through the feet, particularly the heels e.g. basketball or netball