Sever's

HEEL PAIN IN CHILDREN (SEVER’S)
By:  Robert H. Sheinberg, D.P.M., D.A.B.F.A.S., F.A.C.F.A.S.

Painful inflammation to the growth plate (calcaneal apophysis) in the back of the heel.

CAUSE:

  • Over activity in children between the ages of 8 and 14. 
  • Tight muscles in the lower extremity, especially the calf muscles.
  • Flatfeet.
  • Growth spurts.
  • Poor shoe gear or walking barefoot on hard surfaces.

SYMPTOMS:

  • Mild discomfort in the heel bone at the end of an activity.
  • Stiffness in the foot in the morning and pain with walking. 
  • Pain alleviated by rest and a decrease in activity.
  • Stiffness and pain is usually present after a child is done with the activity, sits for a period of time and then tries to get up and walk.

SIGNS:

  • Tenderness to the back and bottom of the heel with touch or grasping the heel.
  • Walking on the ball of the foot to avoid touching the heel to the ground.
  • Discoloration and swelling are almost never seen in the heel.
  • Limping at the end of an activity that may persist as the condition worsens.

TREATMENT:

  • Modification of activity and avoiding going barefooted.
  • Taping the foot to decrease the pulling of the plantar fascia on the heel bone.
  • Proper shoe gear and heel lifts to decrease tension on the heel.
  • Night splinting to stretch the tight calf muscle and arch ligament.
  • Custom molded orthotics to support the foot and help restore proper alignment.
  • Physical therapy to improve flexibility and diminish inflammation of the growth plate.
  • Occasional immobilization in a cast or brace to completely rest the heel and allow healing.