By Dr Kristin Webb (Chiropractor)

Has your child or teenager developed a limp? Do they have a sudden onset of heel pain? Are they struggling to weight bear on one foot?

Has your child complained of foot pain during and after sport?

Have they had heel pain in the past which has resolved but keeps coming back?

Calcaneal apophysitis, also know as Sever’s disease is one of the most common causes of heel pain in children and young adolescents. 

Most common in active kids, particularly those who participate in:

    • Basketball
    • Soccer, football
    • Gymnastics
    • Dance
    • Track and field running

Average age for this condition is 8-12 years of age, more common in boys than girls.

In 66% of cases condition will occur in both heels. They may occur simultaneously or move from one side to the other.

What’s causing this condition?

An apophysis is a growth plate which allows for growth of bones in kids and young adolescents.

In the heel (calcaneus) this growth plate is located at the attachment of the achilles tendon of the calf muscle. As this growth plate is not yet fused in kids, it is vulnerable to overuse injury.

Factors which contribute to this are:

    • Participation in sports which involve running and jumping
      • ie: soccer, football, basketball, gymnastics, dance
    • Abnormal heel strike – ie: poor footwear/shoes, running or walking gait, football cleats/boots.
    • Rapid growth spurts causing increased tension on the achilles tendon.

This condition will typically fluctuate in symptoms – it will have periods in which is very symptomatic and painful and then resolve for a period of time.

Kids and teenagers who are prone to Severs will likely go through periods of flare ups and resolution until the apophysis fuses around 12-15 years of age.

Things to look for as a parent, teacher or coach:

    • Active kid or teenager
    • Recent growth spurt
    • Limping
    • Difficulty weight bearing on one or both feet
    • Increase in activity – ie: starting a new sport, start of sport season, training for multiple sports per week, resuming activity after time off.
    • Complaining they don’t want to play a sport they typically love
    • Complaining of other “growing pains”
    • No history of trauma ie: falls, contact, tackles, etc.
    • Gradual onset/worsening
    • Worse with activity or after playing sport
    • Eased by supportive shoes ie: trainers, running shoes
    • Worsened barefoot or football boots
    • Poor flexibility
    • Flat feet

How can a Chiropractor help?

Management is best guided by a Chiropractor.

Treatment includes:

    • Excluding other pathology such as fractures, bursitis, accessory ossicles, fat pad syndrome, etc. through a physical examination and referral for imaging as appropriate.
    • Management of pain and symptoms during flare ups.
    • Releasing tight muscles, improving hips, knee, foot and ankle mobility.
    • Advising appropriate stretches and strengthening exercises.
    • Educating kids on what their condition is and how to manage flare ups.
    • Helping plan a graded return to activity & sport.
    • Fitting heel lift or cups.