Sever’s disease is a common cause of heel pain in young athletes. It’s typically seen in kids ranging from 8 to 15 years old. It is common in sports that involve running, such as soccer, and repetitive impact, such as gymnastics. It is an inflammation or irritation of the growth plate on the back of the calcaneus (heel bone).

Signs and symptoms of Sever’s disease

Young athletes with Sever’s disease typically complain of heel pain with sports or activity. The pain usually gets worse with an increase in activity. The pain almost always goes away after activity or with rest. Unlike plantar fasciitis, which typically causes heel pain that is felt on the sole of the foot, Sever’s disease usually has pain on the back of the heel just past where the Achilles tendon attaches. Often a sports medicine physician can diagnose Sever’s disease by eliciting tenderness on the posterior aspect of the calcaneus or by squeezing the sides of the calcaneus together to reproduce the pain. X-rays will often show increased density of the growth area on the back of the calcaneus.

Location of foot and heel pain with Sever's disease
The location of the pain in Sever’s disease is typically on the back of the heel (white arrow) more than on the sole of the foot.

Treatment of Sever’s disease

Treatment is always nonoperative. If the pain is significant, the athlete can use crutches and keep weight off of the heel to decrease the pain. Often normal walking is not painful, so crutches are usually unnecessary. Rest from the offending activities, such as soccer and gymnastics, is essential to decrease the pain. Ice, anti-inflammatory medications, and rest are often all that is needed to resolve the symptoms. Sometimes heel cups can be helpful to prevent stress on the calcaneus. Stretching exercises for the Achilles and hamstrings, either performed alone or with a physical therapist, can be helpful as well. If the symptoms are not improving, a night splint or even a short leg cast can be useful to eliminate the symptoms. Return to sports is variable, but the athlete can go back to play whenever the symptoms resolve to the point that the he or she can play without pain. There are no long-term complications of this injury.

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