Growth plates (apophyses) are areas at the ends of the long bones of children in which new bone growth is occurring. They are made up of cartilage and will determine the future length and shape of the mature bone. Apophyses throughout a growing body tend to fuse near the end of puberty, anywhere from 12-17 years old.
Sever’s syndrome, also known as calcaneal apophysitis, occurs at the growth plate in the calcaneus. Although sometimes called a “disease”, this common condition should be thought of as more of an injury than a disease. This condition occurs when the heel bone grows faster than the surrounding tendons and muscles, causing the Achilles tendon to pull on the calcaneus where the apophysis is.
This causes inflammation and in turn, pain. The pain worsens during a growth spurt or physical activity. This condition is not serious and does not pose long term risk. It resolves once the growth plates close, although the pain can be prominent and needs to be addressed to prevent recurrence during childhood and adolescence.
Certain biomechanical factors can trigger, and influence, this condition. High activity levels of higher impact sports and activities can lead to its onset. High impact activities include things like running (especially on hard surfaces), and jumping. In addition, foot type can be a factor. Feet that overpronate, those with a tight Achilles tendon and/or tight gastrocnemius complex, and those with significant calcaneal eversion will apply torque to the growth plate and increase symptoms.
Added weight during childhood and adolescence will put more strain on the area and increase risk. Another factor is wearing flat and unsupportive shoes.
Sever’s syndrome typically affects those between the ages of 9 – 14, especially those who are physically active. Timing may differ by gender due to the varying growth spurt ages typical for girls and boys. For example, girls tend to experience growth spurts between the ages of 9-13, whereas boys tend to experience growth spurts between the ages of 10-14.
- Heel pain in either one or both heels
- Pain may come and go depending on the forces being applied to the area at the time. Pain will worsen during strenuous activity (like running and jumping), or while doing new kinds of movements with the feet
- Pain and tenderness upon palpation
- Redness and swelling at the back of the heel
- Child may appear to limp, or may choose to walk on tip-toe to lessen the pain
- Pain lessens with rest
- Supportive and well fitting shoes
- Cleated shoes can increase risk and symptoms. Opt for running shoes with a good tread instead. If cleates use are to be worn, choose those with a softer and smaller cleated pattern
- Regular and adequate stretching exercises
- Limit running and jumping on hard surfaces
- Maintenance of a healthy weight
- Proper rest and recovery if heel pain arises
Treatment for Sever’s syndrome is the same as its prevention. This is a disease that may come and go until the growth plate closes. Even so, kids who are overpronaters or have the risk factors noted above are at risk for developing foot issues in adulthood, such as plantar fasciitis.
Foot orthotics can be used as a treatment option for Sever’s syndrome now, as well as a preventative measure for such problems later. A deep heel cup, extrinsic rearfoot post, possible heel raise, and sufficient biomechanical control will reduce the rotational stress on the heel.