When recurring heel pain occurs in children, it is usually due to Sever’s Disease, while adult heel pain is usually due to heel spurs, plantar fasciitis, or retrocalcaneal bursitis (Haglund’s Deformity).
- Calcaneus is the anatomical name of the heel bone.
- Sever’s Disease or Calcaneal Apophysitis is an inflammation of the growth plate located at the posterior aspect (back) of the heel.
Sever’s Disease is most commonly seen in physically active girls and boys from ages 10 to 15 years old. These are the years when the growth plate is still “”open,”” and has not fused into mature bone. Also, these are the years when the growth plate is most vulnerable to overuse injuries, which are usually caused by sports activities. The most common symptoms of this disease include:
- Heel pain in one or both heels.
- Usually seen in physically active children, especially at the beginning of a new sports season.
- The pain is usually experienced at the back of the heel, and includes the following areas:
- The back of the heel (that area which rubs against the back of the shoe).
- The sides of the heel. Actually, this is one of the diagnostic tests for Sever’s Disease: squeezing the rear portion of the heel from both sides at the same time will produce pain. It is known as the Squeeze Test.
Causes & Predisposing Factors
The foot is one of the first body parts to grow to full size. During the time of growth, bones grow faster than muscles and tendons. This results in the muscles and tendons becoming tight. The strongest tendon that attaches to the heel is the Achilles Tendon. It attaches to the back of the heel at the site of the growth plate, and during sports activities it pulls with great force on the growth plate. If this pull by the tight Achilles Tendon (calf muscle) continues for long periods of time, the growth plate may become inflamed and painful. If exertive activities continue, Sever’s Disease may result.
Predisposing Hereditary Factors: These is a biomechanical defect that one may be born with, which increases the chances of developing Sever’s Disease:
- Short Achilles Tendon: When the Achilles Tendon is short from birth, it will exaggerate the tightness of this tendon that occurs during a child’s growing years. This makes the pull of the Achilles Tendon on the heel’s growth plate more forceful than normal, causing inflammation and pain, and eventually Sever’s Disease.
- Short Leg Syndrome: When one leg is shorter than the other, the foot on the short leg must plantar flex (the foot and toes bend down) in order to reach the ground. In this way, the body tries to equalize the length of the legs. In order for the foot to plantar flex, the Achilles Tendon must pull on the heel with greater force than if the leg was a normal length. Thus the heel on the short leg will be more susceptible to Sever’s Disease during the foot’s growing years.
- Pronation: Is a biomechanical defect of the foot that involves a rolling outward of the foot at the ankle, so that when walking, the inner side of the heel and foot bears more of the body’s weight than is normal (click here for more information about pronation). Pronation thus causes the heel to be tilted or twisted. In order for the Achilles Tendon to attach to the heel, it must twist to reach its normal attachment site. This will shorten or tighten the Achilles Tendon and increase the force of its pull on the heel’s growth plate. This will increase the tightness of the Achilles Tendon during the foot’s growing years, and may help to initiate bouts of Sever’s Disease.
- Flat Arches and High Arches: Both of these biomechanical foot defects effect the pitch, or angle of the heel within the foot. When the heel is not positioned normally within the foot due to the height of the arch, the Achilles Tendon’s attachment to the heel is affected. This may produce a shortening or tightening of the Achilles Tendon, which increases the force of its pull on the heel’s growth plate. During the foot’s growing years, abnormal arch height may contribute to the onset of Sever’s Disease.
The old adage, “An once of prevention is worth a pound of cure,” is most appropriate when trying to prevent the effects of Sever’s Disease. If this condition is not prevented, or treated in its earliest stages, it may cause the child to stop certain sports activities until the growth plate has fused and matured (this usually occurs around the age of 16 years old).
- Long Term Treatment and Prevention must be directed towards protecting the growth plate at the back of the heel during a child’s growing years. Being aware of the following best does this:
- If the child is very active in sports that require repetitive and exertive activities, then the parents must be vigilant when it comes to the child’s gait, watching to see if he or she is limping, walking on their toes, or complaining of heel pain when weight-bearing. These may be “early warning signs” of Sever’s Disease.
- Along with these signs, if your child has any of the Predisposing Hereditary Factors listed above, the chances of Sever’s Disease occurring increased.
Custom-Made Sports Orthotics For Sever’s Disease:
From the impressions of your child’s feet that you make with our Foam Impression Kit, and the information you provide us with, we design and construct a pair of orthotics that help to overcome the causes of Sever’s Disease. Our orthotics is constructed of thin, comfortable, durable, shock absorbent “space age” materials. These materials compress as you place your weight on the orthotic, thus absorbing the shock of each step, rather than passing on these shocks to the growth plate, heel, and foot. When you remove your weight from the orthotic, the orthotic returns to its original shape and height (much like the shock absorbers on an automobile). This occurs because the materials we use have a “memory.” Also, these materials will comfortably keep the foot in its proper alignment. In addition, our orthotics are constructed to:
- Cushion the painful heel. The proper padding will cushion and protect the heel each time your child steps on their foot. This will help to provide comfort when weight-bearing.
- Optimally elevate the heel. When the rear portion of the heel is elevated the proper amount, the Achilles Tendon’s forceful pull is reduced, thus lessening the tendon’s pull on the growth plate. Without this abnormal pull on the growth plate, the chances of the growth plate becoming inflamed and painful are greatly reduced. This will reduce the chances of Sever’s Disease occurring. (Heel lifts for Short Leg Syndrome can also be added, if needed).
- Re-balancing the foot, and maintaining it in its proper alignment with our uniquely placed wedges, will help to control the biomechanical foot defects which predispose the foot to Sever’s Disease. When the foot is in its proper alignment, the chances of Sever’s Disease occurring is greatly reduced.
- Support the arch at its optimal height. This will help to hold the heel in a neutral position. When the heel is in a neutral position it has a more normal pitch (angle). This will reduce the abnormal pull of the Achilles Tendon on the heel’s growth plate, thus helping to reduce the chances of Sever’s Disease from occurring.
The following products can be effective in helping to reduce the pain of Sever’s Disease; however, they do not help to correct the underlying cause of Sever’s Disease as custom-made orthotics do.
Wondercup Soft Silicone Heel Cushions: These heel cushions are made out of a super-shock absorbing, medical grade soft silicone. They will help to cushion and protect the heel each time your child takes a step. Also, because of the thickness of the silicone cushion, the heel is slightly raised, which will help to reduce the pull of the Achilles Tendon on the tender and inflamed growth plate. These features help to provide relief, especially when the Heel Cushions are used in conjunction with the following Self-Help Treatments.
Superfeet Green Insoles: Perfect for hiking, running, walking, skiing, and work boots. These are Superfeet’s most popular footbeds. The Synergizer Footbeds have the most advanced features built into them for maximum support, balance, comfort, and shock absorption. The Patented Rear-Foot Control Point helps to control over-pronation, thus helping to keep your feet correctly aligned. Result: less stress on muscles, bones, and joints. These features help to provide relief, especially when the Heel Cushions are used in conjunction with the following Self-Help Treatments.
Superfeet Blue Insoles: Perfect for: 1. Soccer, football, baseball, and track cleats. 2. Casual and sport foot gear that does not have removable inner soles. These footbeds are a little thinner, thus allowing them to work well in low-volume footwear. Although they are thinner, they will still provide you with the support and comfort that you need. It is easy to trim these footbeds with just a scissors. The Synergizer Footbeds have the most advanced features built into them for maximum support, balance, comfort, and shock absorption. The Patented Rear-Foot Control Point helps to control over-pronation, thus helping to keep your feet correctly aligned. Result: less stress on muscles, bones, and joints. These features help to provide relief, especially when the Heel Cushions are used in conjunction with the following Self-Help Treatments.
Self-Help Treatments & Exercises
Immediate Self-Help Treatment should begin when symptoms of Sever’s Disease first appear. These treatments can include:
- Eliminate all unnecessary weight-bearing activities, especially sports activities. This will limit the pull of the Achilles Tendon on the heel’s growth plate, and allow it to begin to heal. Continue this until all symptoms are gone.
- Apply ice to the back of the heel for 20 minutes, several times a day. The ice should just cool the area, and not make it uncomfortably cold. If the pain increases with the use of ice, stop it immediately. Ice will help to reduce the inflammation of the growth plate.
- Wear a shoe with an open back, such as a sandal or clog. When the shoe is backless, there is nothing to rub on the back of the heel. This reduces pressure on the tender growth plate, and allows it to heal more quickly.
- Wear a shoe with a higher heel. Elevating the heel will decrease the force with which the Achilles Tendon pulls on the growth plate, allowing the pain to gradually subside. For guys: wear an open back shoe. Place a ¼” felt or foam pad on the heels innersole. This will elevate the heel. (You can purchase felt or foam material at some craft stores or medical supply stores. Cut the material to fit in the heel of the shoe).
- When lying on your back, place a pillow under the calf of your leg so that your heel does not touch the surface you are lying on. This will reduce pressure on your heel.
Physicians usually recommend that these treatments be continued until all of the pain subsides. A gradual and sensible return to all weight-bearing activities is encouraged. In my experience, custom-made sports orthotics will facilitate a quicker return to all activities, especially sports.