Sever's disease

This leaflet provides information for children, adolescents and their parents on Sever’s disease and offers some exercises to help improve symptoms.

Please note this information is a guide only. Please consult your child’s physiotherapist at Addenbrooke’s Hospital, Physiotherapy Outpatients on 01223 216633 for individual advice and recommendations.

About Sever’s disease

Sever’s disease is a common condition affecting the heel bone in children and adolescents. Young people experience pain over the heel when taking part in physical activities. The calf muscles are attached to the heel bone (calcaneus) by the Achilles tendon.

Bones grow quicker than muscles and tendons when a child goes through a period of increased growth. The calf muscles have to catch up with the bone growth and as a result become tight. The Achilles tendon pulls repeatedly on the heel bone causing pain and swelling in the heel, especially if taking part in high impact activity such as running and jumping.

What are the symptoms?

• The repetitive pull of the calf muscles through the Achilles tendon, attached to the heel, may cause the individual to limp or walk on their toes due to the heel pain.
• Resting often alleviates the pain.
• One or both heels can be affected.
• The heel is tender if squeezed.
• There is local swelling where the Achilles tendon meets the bone.
• The calf muscles may be tight.

How to make it better

Usually the pain in the heel will settle when the individual stops growing, meanwhile, the following may help with the pain:

• Modifying activities often helps to settle pain and swelling. If the pain is very bad, it may be helpful to avoid high impact sports that involve running and jumping until the pain decreases. Swimming and cycling are low impact activities which place less stress on the joint. This type of exercise is recommended rather than more strenuous ones if the heel is very painful.
• The young person can continue to play sports, but the pain may take longer to settle down. There is no evidence to suggest that playing sports causes long term damage to the structures at the heel.
• Rest allows swelling to subside.
• Elevate the leg after sports to allow pain and swelling to settle.
• Once the pain has ceased, participation in physical activity and sports should be increased gradually.
• It may be helpful to apply ice to the heel for 10 to 15 minutes, especially after physical activity. Make sure the skin is protected by wrapping the ice in a towel.
• ‘Shock absorbing’ insoles may be of benefit in shoes or trainers to ease pain and swelling. Gel heel cups can be helpful in decreasing pain too.
• Supportive footwear is recommended. Any activity done in bare feet may be painful and should therefore be avoided.

How long will it take for the pain to settle?

Sever’s pain will usually settle with rest and activity modification. Once the young person has stopped growing, the heel bone will no longer be painful.

Calf stretches

The following stretches are helpful in improving muscle flexibility.

Deep calf stretch (soleus)

Stand with one foot in front of the other, holding on to a sturdy support. Keep the feet pointing forwards. Bend both knees and keeps your heels in contact with the floor. You should feel a stretch in the lower calf of the back leg.
Hold for ___ seconds then relax.
Repeat ___ times.

Calf stretch (gastrocnemius)

Stand with one foot in front of the other holding on to a sturdy support with the leg to be stretched straight behind you and the other leg bent in front of you. Lean your body forwards, pushing the back heel towards the ground. You should feel the stretch in the calf of the straight leg.
Hold for ___ seconds then relax.
Repeat ___ times.

If the child or adolescent goes through another growth spurt, the pain may affect them again. Therefore, they may have to temporarily cut back on high impact activities until the pain decreases. They should continue with the above stretches.