Sever's Disease (Calcaneal Apophysitis) in Children: Care Instructions

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Sever's disease (calcaneal apophysitis) is heel pain and inflammation of the calcaneal growth plate. This growth plate is between the bottom of your child's Achilles tendon and the heel bone. Certain young athletes, such as runners, gymnasts, and soccer or basketball players, are more likely to have this type of heel pain.

Growth plates are the areas near each end of the long bones in children and adolescents where bone growth occurs. This developing tissue determines how long and wide the bone will be when fully grown. During late adolescence, when growth stops, the growth plates close and are replaced by solid bone. Until then, the growth plate is relatively weak and vulnerable to trauma.

Rest, anti-inflammatory pain medicine, heel cushions, and stretching exercises can help decrease heel pain and inflammation.

Follow-up care is a key part of your child's treatment and safety. Be sure to make and go to all appointments, and call your doctor if your child is having problems. It's also a good idea to know your child's test results and keep a list of the medicines your child takes.

How can you care for your child at home?

  • Have your child rest their feet often. Reduce your child's activity to a level that lets your child avoid pain. Remind your child to not run or walk on hard surfaces.
  • Give anti-inflammatory medicines such as ibuprofen (Advil, Motrin) to reduce heel pain and swelling. Read and follow all instructions on the label.
  • Put ice or a cold pack on your child's heel for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when your child is awake). Put a thin cloth between the ice and your child's skin.
  • If the doctor says it is okay, teach your child the following calf stretches. Tight calf muscles can cause heel pain or make it worse. Have your child do these stretches 3 or 4 times a day.
    • Have your child stand facing a wall with their hands on the wall at about eye level. Then have your child put the leg they want to stretch about a step behind the other leg. Keeping the back heel on the floor, your child should bend the front knee until they feel a stretch in the back leg. Hold the stretch for 15 to 30 seconds. Have your child do this stretch 2 to 4 times.
    • Have your child sit down on the floor or a mat with both feet stretched in front of them. Then have your child place a rolled towel under the ball of one foot, holding the towel at both ends. Your child should gently pull the towel toward themself while keeping the knee straight. Hold the stretch for 15 to 30 seconds. Have your child do this stretch 2 to 4 times.
  • Have your child wear shoes with good arch support. Athletic shoes or shoes with a well-cushioned sole are good choices.
  • Try a heel lift, heel cup, or shoe insert (orthotic) to help cushion your child's heel. It's important to use a heel lift, heel cup, or shoe insert on both feet for balance. You can buy these at many shoe stores.

When should you call for help?

Call your doctor now or seek immediate medical care if:

  • Your child has severe heel pain.
  • Your child's heel pain is getting worse.

Watch closely for changes in your child's health, and be sure to contact your doctor if:

  • Your child's heel pain has not gotten better after 2 weeks.

Where can you learn more?

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The Health Encyclopedia contains general health information. Not all treatments or services described are covered benefits for Kaiser Permanente members or offered as services by Kaiser Permanente. For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. For recommended treatments, please consult with your health care provider.