Sever’s Syndrome

Sever’s disease is a painful irritation of the apophysis (growth plate) at the back of the calcaneous (heel bone) related to Achilles tendon tightness. It is most often seen in physically active boys and girls between the ages of 8 and 13 years. It is the most common cause of heel pain in this age group and occurs in all sports. It can occur on both heels about 60 percent of the time. It is caused by repetitive tension at the growth center.

Symptoms

Symptoms of Sever’s syndrome include:

  • Pain in the heel that occurs during or after activity.
  • Pain that worsens with wearing cleats.
  • A limp (usually noticed by the parent).

Diagnosis

Sever’s disease is diagnosed based on physical examination. An X-ray should be done to make sure there are no fractures, but there are no X-ray findings consistent with Sever’s syndrome.

Treatment

Treatment is a period of rest from painful activities in order to take pressure off the growth center and allow inflammation to resolve.

  • Ice is very helpful in reducing pain and inflammation.
  • It is very important to stretch tight calf muscles in order to relieve tension on the growth center and prevent recurrence of this problem.
  • Occasionally, casting is needed to limit activity and relieve inflammation at the heel. Gel heel cups can alleviate some of the pain as activities resume.
  • Wearing shoes with minimal-sized cleats under the forefoot can offload the pressure seen at the heel apophysis and minimize recurrence.

Return to sports should only be permitted when pain is gone and there is no limp.