Severe disease in children causes symptoms and treatment

Have you ever noticed your child complaining of heel pain after playing or running? This could be Sever’s Disease, also known as heel inflammation in children.This condition is very common in children aged 8 to 14 years, especially those who are active in sports or going through a rapid growth phase. The important thing to know is that, although the pain may make your child walk on tiptoes or limp temporarily, Sever’s Disease is not dangerous and usually goes away over time with proper care.

In this Dalili Medical article, we will cover everything you need to know about Sever’s Disease:

• Its true causes

• The symptoms you should watch for

• Effective non-surgical treatments

• Tips before and after treatment to ensure complete recovery

1️⃣ What is Sever’s Disease?

Sever’s Disease is inflammation of the growth plate in the heel in children.

• Most common in children aged 8 to 14 years.

• Main cause: pressure on the heel during growth or sports activity.

2️⃣ Does Sever’s Disease cause a heel fracture?

❌ No.
Sever’s Disease is not a fracture, it’s an inflammation of the growth plate.
However, the pain may cause the child to walk abnormally.

3️⃣ Can it affect just one foot?

✅ Yes.
Sometimes it appears in one heel, sometimes in both, depending on activity level or pressure on the foot.

4️⃣ Can Sever’s Disease go away without treatment?

It usually improves gradually as the growth plate closes.

• Rest and stretching exercises help reduce pain and speed up recovery.

5️⃣ Can the child still play sports?

• Light activities are allowed after controlling pain.

• Running or intense jumping should be avoided until pain disappears completely.

6️⃣ Is Sever’s Disease hereditary?

❌ No.
The cause is mechanical, due to pressure on the heel during growth, not genetic.

7️⃣ Does the child need a foot orthotic?

• In cases of flat feet or high arches, a heel pad or supportive shoe may help.

• Not necessary for every child, but it reduces pain and prevents worsening.

8️⃣ Can the pain last throughout the growth period?

• Pain is usually temporary, appearing with activity or afterward.

• Rest and exercises reduce duration and intensity.

9️⃣ Can children under 8 get Sever’s Disease?

❌ Very rare.
Most cases occur between 8–14 years because the growth plate is more vulnerable.

???? Can inflammation spread to the knee or the other foot?

• Pain may affect walking, straining the knee or the other foot.

• But the disease does not spread from one foot to another.

1️⃣1️⃣ Can it be completely prevented?

Yes, the risk can be significantly reduced by:

• Supportive and cushioned shoes

• Stretching exercises before and after activity

• Reducing high-impact activity if pain occurs

• Maintaining a healthy weight

1️⃣2️⃣ Is Sever’s Disease dangerous?

❌ No.

• It’s not serious and does not cause permanent complications.

• Pain may worsen if the child continues intense activity.

• Following proper rest and treatment ensures complete recovery.

1️⃣3️⃣ Does Sever’s Disease require surgery?

❌ No, never.
Treatment is conservative only: rest, supportive shoes, exercises, and pain relief if needed.
Surgery is not required.

1️⃣4️⃣ Does it go away completely?

✅ Yes.
It usually disappears when the heel finishes growing.

• Following rest and exercises prevents recurring pain.

1️⃣5️⃣ Does it affect adults?

❌ No.
It only affects children and adolescents during growth, because their growth plate is still open.

1️⃣6️⃣ How to prevent it?

• Choose padded and supportive shoes

• Perform stretching exercises before and after activity

• Reduce high-impact activities if the child feels pain

• Maintain a healthy weight

1️⃣7️⃣ Causes of Sever’s Disease

1. Rapid growth

• During growth spurts (8–14 years), the heel bone grows faster than muscles and tendons, causing tension and inflammation in the growth plate.

2. Excessive physical activity

• Running, jumping, playing football, basketball, or other high-impact sports, especially daily.

3. Improper footwear

• Flat or hard shoes without heel support increase pressure and inflammation.

4. Excess weight

• Extra weight increases pressure on the heel and accelerates inflammation.

5. Tight calf muscles

• Short or tight calves increase tension on the Achilles tendon, affecting the heel.

6. Standing or walking for long periods

• Especially on hard surfaces without sufficient rest.

7. Flat feet or high arches

• Abnormal foot shape changes weight distribution, putting more pressure on the heel.

1️⃣8️⃣ Symptoms of Sever’s Disease

1. Heel pain

• Most common symptom, located at the back or bottom of the heel.

• Worse during running, jumping, or playing sports.

• Improves with rest.

2. Pain after activity

• The child may play normally, but pain appears after exercise or at night.

3. Limping

• Child may walk with a limp or favor one foot after a day of activity.

4. Walking on tiptoes

• Some children walk on the forefoot to reduce heel pressure.

5. Tenderness to touch

• Pressing on the heel causes localized pain.

6. Mild swelling or warmth

• Sometimes slight redness or swelling without bruising.

7. Stiffness in the foot or leg

• Especially after waking up or sitting for long periods.

8. One or both feet affected

• May appear in one or both heels, which is normal in Sever’s Disease.

1️⃣9️⃣ When to see a doctor

Seek medical attention if:

• Pain is severe and unbearable

• Pain persists despite rest

• Significant swelling or heat in the heel

• Child refuses to walk

2️⃣0️⃣ Most at-risk groups

1. Children in growth phase

• Usually aged 8–14 years

• Slightly more common in boys than girls

• Cause: open growth plate in the heel

2. Active children / athletes

• Especially those in sports involving:

  • Running

  • Jumping

  • Quick changes of direction (football, basketball, track & field)

3️⃣ Children going through rapid growth spurts

During growth spurts:

• Height increases rapidly

• Muscles may not keep up with bone growth

• This causes tension on the heel and temporary pain

4️⃣ Children with foot problems

Such as flat feet or high arches:

• Weight distribution is uneven

• More pressure is put on the heel than normal

5️⃣ Children who are overweight

• Extra weight increases load on the heel

• Pain may occur even if the child is not very active

6️⃣ Children wearing improper shoes

Shoes that are:

• Very flat

• Hard without heel support

• Old or worn out
  All of these increase heel pressure and contribute to inflammation

7️⃣ Children who stand or walk for long periods

• Especially on hard surfaces

• Examples: long trips, extended training sessions

• This increases heel stress and pain

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Types of Sever’s Disease

1️⃣ Sever’s Disease due to overactivity

• Cause: continuous running, jumping, ball games

• Most common in active children/athletes

• Pain increases during activity and decreases with rest

2️⃣ Sever’s Disease due to rapid growth

• Appears during growth spurts

• Bone grows faster than muscles

• Causes strong tension on the Achilles tendon and heel

• Usually occurs without intense activity

3️⃣ Sever’s Disease due to Achilles tendon tightness

• Caused by short or stiff calf muscles

• Pain is noticeable at the back of the heel

• Increases when walking on hard surfaces

4️⃣ Sever’s Disease due to foot shape issues

• Flat feet or high arches

• Weight distribution is uneven → puts extra pressure on the heel

5️⃣ Sever’s Disease related to overweight

• Extra weight increases load on the heel

• Pain can occur even with minor effort

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⚡ Sever’s Disease severity levels

Mild

• Light pain

• Appears after activity only

• Child can walk normally

Moderate

• More noticeable pain

• Slight limp

• Requires rest and physical therapy

Severe

• Strong pain

• Child refuses to walk

• May require medical shoe, heel support, or medical follow-up

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⚠️ Risks of Sever’s Disease

• Increased pain severity if activity continues despite discomfort

• Persistent inflammation → pain becomes stronger and longer

• Limping or walking difficulties → may strain knee, hip, or lower back temporarily

• Impact on sports activity → child may need to pause playing

• Psychological impact if the child does not understand their condition

• Pain recurrence if returning to activity too soon or wearing improper shoes

• Misdiagnosis or delayed treatment → prolongs pain duration

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⚡ Diagnosis of Sever’s Disease

1️⃣ Medical history

Doctor asks about:

• Child’s age (usually 8–14 years)

• Participation in sports

• Nature of the pain:

  • Increases with running/jumping?

  • Decreases with rest?

• One heel or both?

• Recent growth spurt?

If these match → high suspicion of Sever’s Disease

2️⃣ Clinical examination

• Heel squeeze test → pain indicates Sever’s Disease

• Achilles tendon assessment → check for tightness or stiffness

• Observation of walking → look for limping or tiptoe walking

3️⃣ Imaging (if needed)

• X-ray rarely required

• Helps rule out: fractures or other bone issues

• Usually X-rays are normal in Sever’s Disease

4️⃣ Rule out other conditions

• Stress fracture of the heel

• Achilles tendinitis

• Plantar fasciitis

• Joint inflammation

⚠️ When to suspect something else

• Severe swelling or heat

• Persistent pain at rest

• Difficulty walking

• Age <6 or >15 → further tests needed

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⚡ Best exercises for Sever’s Disease

1️⃣ Wall calf stretch

• Stand facing a wall, hands on wall

• One foot forward, one foot back (back foot straight, heel on ground)

• Lean forward slowly

• Hold: 20–30 sec × 3, twice daily

2️⃣ Achilles tendon stretch

• Same wall position, back knee slightly bent

• Feel stretch under calf and behind heel

• Hold: 20 sec × 3, twice daily

3️⃣ Foot towel stretch

• Sit on floor, legs straight

• Place towel around foot, gently pull toward body

• Hold: 20–30 sec × 3

4️⃣ Heel raises

• Stand holding chair, rise on tiptoes, lower slowly

• Reps: 10 × 2 sets, once daily
  ⚠️ Stop if pain occurs

5️⃣ Rolling ball or water bottle

• Sit, place small ball or cold bottle under foot, roll gently

• Duration: 5 min daily

6️⃣ Seated calf stretch

• Sit, extend leg, pull foot toward body gently

• Hold: 20–30 sec × 3, twice daily

7️⃣ Ankle flexion/extension (no weight)

• Sit or lie down, move foot up and down

• Reps: 15–20 × 2
  ✔ Strengthens ankle without heel pressure

8️⃣ Resistance band stretch

• Wrap band around foot, pull up against resistance, release slowly

• Reps: 10–15 × 1–2 sets

9️⃣ Toe pick-up exercise

• Pick up objects with toes (papers, pencils)

• Duration: 3–5 min daily
  ✔ Strengthens foot muscles, reduces heel pressure

10️⃣ Single-leg balance

• Stand on one leg, 10–15 sec, switch legs, 3x per leg
  ⚠️ Stop if pain occurs

11️⃣ Walking on soft surfaces

• Light walking on carpet or sand, no running

• Duration: 3–5 min

12️⃣ Massage ball roll

• Sit or stand, roll small ball under heel back and forth

• Duration: 2–3 min daily

13️⃣ Toe walking

• Walk on toes on soft surface for 2–3 meters, repeat twice daily
  ⚠️ Stop if pain increases

14️⃣ Heel walking

• Walk on heels, toes raised, short distance
  ✔ Strengthens back calf muscles

15️⃣ Ankle circles

• Sit, lift one leg, rotate ankle clockwise and counterclockwise

• Reps: 10–15 per foot

16️⃣ Resistance band calf stretch

• Band around heel, pull foot gently backward against resistance

• Reps: 10–15 per foot

17️⃣ Stair climbing carefully

• Step up slowly, support on wall or railing, no jumping
  ✔ Strengthens calf muscles without heel stress

18️⃣ Ball pick-up

• Sit or stand, pick up small ball with toes

• Duration: 3–5 min
  ✔ Strengthens small foot muscles, improves balance

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⚡ Medications for Sever’s Disease

1️⃣ Simple pain relievers

• Use only when needed

• Examples: Paracetamol (children’s dose)

• Safe, reduces pain without stomach issues

• Dose: according to age/weight, under doctor supervision

2️⃣ NSAIDs

• For moderate to slightly severe pain

• Examples: Ibuprofen, Diclofenac (children’s syrup)
  ✔ Reduce inflammation, swelling, and pain
  ⚠️ Important: take after food, short course (3–7 days), avoid if child has stomach issues or allergies

3️⃣ Topical creams

• Anti-inflammatory gels or mild pain relief creams

• Apply to heel twice daily
  ✔ Supportive only, not essential

❌ Medications to avoid

• Cortisone (oral or injection)

• Local steroid injections

• Strong rheumatism medications
  ⚠️ Dangerous for growth plate

⏱ Medication duration

• Usually 3–7 days

• Stop once pain improves, continue rest and exercises

• Important: if child takes medication but keeps running → pain may persist longer

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⚡ Tips before treatment

1. Rest and reduce pressure

• Limit running, jumping, high-impact games

• Light activities like walking or cycling on soft ground are better

2. Choose proper shoes

• Cushioned, flexible, supportive

• Avoid very flat or old shoes

3. Stretch before activity

• Calf and Achilles stretches reduce heel tension

4. Warm-up packs

• Light warm compress before activity reduces tension

5. Monitor weight and activity

• Overweight increases heel stress

• Regulate playtime to reduce pain

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⚡ Tips during treatment

• Apply ice packs after activity for 15–20 min

• Follow daily stretching program

• Use heel cups inside shoes to reduce pressure

• Stop activity immediately if child reports severe pain

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✅ Tips after improvement & recovery

1. Continue light exercises

• 2–3 times per week to maintain calf and heel flexibility

2. Gradual return to sports

• Start with light jogging → jumping → full activity

• Avoid sudden heel pressure

3. Monitor shoes

• Keep cushioned, supportive shoes

• Replace if tight or worn

4. Follow-up

• If pain returns → reduce activity and repeat exercises

• Mild pain during growth is normal