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The Informed Parent

Sever’s Disease

by Louis P. Theriot, M.D., F.A.A.P.
Published on Jan. 01, 2000

Dear Dr. Theriot,

My 10 year old son is playing soccer. Off and on for the past month he has complained of severe heel pain in his right foot. He says that he didn't injure it, and it is not swollen. Sometimes it bothers him to the point that he limps. Other times it doesn't bother him at all. I keep waiting for it to go away. Should I take him to his doctor, or should I give it more time?

It sounds as if your son might have Sever's disease, which is an inflammation of the area where the Achilles tendon inserts on the heel, near the heel's growth plate. This condition is very common in adolescents, usually between 6-12 years of age. It is basically a direct result of overuse.

Your son should definitely see his doctor to be sure that he has Sever's disease and not something more serious. Other causes of heel pain in this age group are plantar fasciitis, a stress fracture, Achilles tendonitis and very rarely, a tumor. The doctor might want to x-ray the heel to rule out a stress fracture or a tumor, but these conditions are not common.

Treatment of Sever's disease includes:

  1. restricting activity to just walking
  2. if the child limps when he walks, then crutches should be used to avoid weight bearing on the affected foot
  3. icing the heel three times a day for 15 minutes each time
  4. anti-inflammatory drugs
  5. once the limp has resolved, then a 1/4 inch heel pad can be used to relieve the stress on the growth plate
  6. making sure that the shoes are adequately cushioned in the heel
  7. exercises to stretch the Achilles tendon and the plantar fascia.

To stretch the plantar fascia, have your son sit on the floor with both knees bent and both feet flat on the floor. Then have him grab his toes and gently pull the tops of the toes upwards towards his body. To stretch the Achilles tendon, have him lean against the wall (pushing the wall) with one leg bent forward. The back leg (the one with the Sever's disease) should be straight with the foot planted flat on the ground. As he pushes forward, he should feel the stretching sensation of the back leg in the area of the Achilles tendon. Try these yourself and you will feel the areas being stretched.

The prognosis for Sever's disease is excellent provided the patient follows the regimen prescribed by the doctor. After a few weeks of proper treatment, the patients are usually ready to return to their normal activity, and most are able to remain symptom free. A correct diagnosis is imperative however, so your son should definitely see his doctor.

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