Calcaneal Apophysitis-Sever's Disease
Heel pain in children can very commonly be caused by a condition called Sever's disease. While putting the word "disease" in a diagnosis sounds scary, it is truly a resolvable issue. Another term for this is calcaneal apophysitis. Apophysis (or epiphysis) refers to the growth plates that are located throughout the body of a developing child. The "itis" refers to inflammation. Inflammation that occurs in the heel bone (calcaneus) in the area of the growth plate is therefore calcaneal apophysitis.
Children can commonly experience "growing pains" as their bones heal and lengthen and while their growth plates close - and this can occur in any part of the body. The cartilage cells that compose rudimentary bone structure in children are replaced with bone cells as children mature. The name “Sever’s Disease” started James Warren Sever described the apophysitis of the heel bone back in 1912.
This condition presents as pain in the heel. It occurs during an adolescent growth spurt which begins around age 8 and ends around age 16. Sometimes during development, bone may grow at a higher rate than tendons and muscles and because the heel serves as an insertion point to the Achilles tendon, the tendon pulls on the growth plate. Especially in children that are active in sports, this pulling is more frequent and exaggerated. This causes additional motion of the growth plate on the mature bone of the calcaneus and causes pain and inflammation (or micro-swelling).
A funny is that the name of the family in the show "Growing Pains" from the 80's is Seaver!! Maybe it isn't as funny to you, but now you won't forget the name and what it means :)
Initial treatment for this condition typically involves immobilization and rest from activity. The purpose for this is to minimize the motion that is causing irritation and pain in the heel. Because children tend to recover and heal faster than adults, the condition can mostly resolve over the course of a couple of weeks, as long as treatment is sought early. Icing is also helpful to decrease the micro-swelling. Another modality that may be necessary to resolve the condition is an Unna boot. This is a soft cast which can be cut off about 4 days after its application and has a cream with agents that help to decrease inflammation. In some instances, patients may require bracing or custom orthotics to not only improve the condition but also to decrease the predisposition for recurrence. It is important to follow-up after initializing treatment for Sever’s disease, to ensure that the problem is resolving and that there are no other underlying diseases that could be aggravating the problem further.