Kids' Health Sever's Disease and Heel Pain in Children By Vincent Iannelli, MD facebook Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years. Learn about our editorial process Vincent Iannelli, MD Medically reviewed by Medically reviewed by Jonathan B. Jassey, DO on January 03, 2020 facebook Jonathan B. Jassey, DO, is board-certified in pediatrics. He has been in private practice at Bellmore Merrick Medical in New York since 2007 and is the co-author of "The Newborn Sleep Book." Learn about our Medical Review Board Jonathan B. Jassey, DO Updated on January 03, 2020 Print Heel pain is common in children. While it may be the result of a specific injury, it is also commonly caused by something called Sever's disease, a type of overuse syndrome similar to shin splints or Osgood-Schlatter disease. Children with Sever's disease (also known as calcaneal apophysitis) develop micro-fractures where the Achilles tendon inserts on the calcaneus (the large bone that makes up the heel of the foot). These microfractures can cause pain depending on the type of activity your child is doing. The pain generally gets worse with activity and improves with rest. Robert Daly / OJO Images / Getty Images Causes Sever's disease is more common in boys and typically occurs when the child is between 8 and 13 years old. Although it can affect both heels, it more commonly just affects one. It is a disease of overuse, most often caused by playing sports or any activity which involves a lot of heel motion or impact. Sever's disease is commonly seen at the beginning of a school sports season. Children going through adolescent are especially prone to the disease as the heel bone will typically grow faster than the leg. It more often occurs in children whose feet and ankles roll inward when standing (referred to as either "flat feet" or over-pronation). Symptoms and Diagnosis Heel pain is the defining symptom of Sever's disease, located either to the back (posterior) or toward the front adjacent to the arch (plantar). Unlike a heel or ankle injury, there will be little to no swelling or redness. The pain, however, can sometimes be so severe as to cause limping or a tiptoed gait. Diagnosis involves a simple squeeze test in which patient lies prone on the examining table with their knees flexed at 90 degrees. The doctor will then squeeze the heel at the back, middle, and side of the heel to determine where the pain is. Plantar fasciitis is another common cause of heel pain, but unlike Sever's disease, the pain is mostly felt when the activity is first started. After 10 to 15 minutes of activity, the pain will "work itself out" and resolve its own. This is the main differentiator between the two conditions. Treatment Treatment of Sever's disease is focused on a combination of recuperation and physical therapy techniques. Known as the RIME method, the technique involves: Rest (or, in the case of children, relative rest)Ice packs or compressesMassage of the injured footExercises that stretch and strengthen the Achilles tendon, hamstring, and calf muscles Heel pads, lifts, or cups are also recommended to protect the heel and minimize the impact of walking or bumps. A firmer heel pad is better is preferable to softer, cushioned one. For severe pain, a short leg cast for four to six weeks may be helpful. If the pain isn't too bad, a heel pad and exercise may suffice. However, if the symptoms don't improve, immobilization may be needed. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Scharfbillig, R.; Jones, S.; and Scutter, S. "Sever’s Disease." Journal of the American Podiatric Medical Association. 2011; 101(2):133-145.