Sever's Disease

Sever's disease occurs mainly in active children aged 8 to 15 years old and results in pain at the back of the heel.

Symptoms of sever's disease

The main symptom of sever's disease is pain and tenderness at the back of the heel when walking and running. Tenderness will be felt at the back of the heel, especially if you press in or give it a squeeze from the sides. There may possibly be a lump at the back of the heel/heels although this might be minimal. Other symptoms include tight calf muscles resulting in reduced ankle range of motion. Pain may go away after a period of rest from sporting activities only to return when the young person goes back to training.

Causes of severs disease

Tight calf musclesSevers disease is often associated with a rapid growth spurt. As the bones get longer, the muscles and tendons become tighter as they cannot keep up with the bone growth. The point at which the Achilles tendon attaches to the heel becomes inflamed and the bone starts to crumble (a lot like osgood schlatters disease of the knee). Tight calf muscles may contribute as the range of motion at the ankle is reduced resulting in more strain on the achilles tendon.

Sever's disease is the second most common injury of this type which is known as an apophysitis. The condition will usually settle within 6 months, although it can persist for longer.

Treatment of severs disease

The aim of treatment is to reduce the pain and inflammation when gently stretch the muscles. There is likely to be no magic instant cure and the young athlete may have to be patient while they grow.

The athlete can:

Calf stretchingRest and apply ice or cold therapy to the heel. Do not apply ice directly to the skin but wrap in a wet tea towel to avoid ice burns. Rest from activities which cause pain. If running and playing football makes it worse then reduce or stop this activity and try cycling or swimming to maintain fitness.

A temporary measure is to insert a heel pad or heel raise into the shoes. This has the effect of raising the heel and shortening the calf muscles and so taking the strain off the back of the heel. However long term use of a heal raise may shorten the calf muscles when they need stretching.

Stretch the calf muscles regularly. Stretching should be done pain free and very gently with this injury. See a sports injury professional who can advise on treatment and rehabilitation.

A doctor, sports therapist or physiotherapist can:

Apply a plaster cast or boot if the child is in severe pain. This may be worn for a few days or even weeks and should give relief of pain for a while.

Orthotic insertsCarry out a full biomechanical assessment. This may help to determine if any foot biomechanics issues are contributing to the condition. Orthotics or insoles can be prescribed to help correct over pronation or other biomechanics issues.

Prescribe anti-inflammatory medication such as ibuprofen to reduce pain and inflammation. This will not be prescribed if asthma the child has asthma. In persistent cases X-rays may be taken but this is not usual.

A doctor, sports therapist or physiotherapist will NOT give a steroid injection or operate as these are not suitable treatment options.

Expert interview

Premiership Physiotherapist Neal Reynolds talks about growing pains including Sever's Disease.