Calcaneal apophysitis (Severs disease) is a common problem in growing children with the growth plate at the back of the heel bone. The classic symptoms are pain on activity and pain on squeezing the sides of the heel bone. The problem is self limiting and the child will always grow out of it by the early to mid teenage years as the growth plate merges with the rest of the heel bone. Even though they do grow out of it the problem can be quite painful and needs to be treated. It can cause quite a bit of distress in the child, especially after playing sport.
The first approach to the treatment is to manage the loads by reducing physical activity to a level that the symptoms can be managed. This could be a simple reduction in how often they play sport or you may need a more radical reduction in all physical activity if the symptoms are particularly bad. A lot of common sense needs to be used here, especially when it comes to managing the loads, but also keeping the child engaged in their chosen sport. They need to be allowed to stay active but not too active that the symptoms become a problem.
The addition of a cushioning heel pad to protect the area and reduce the pull on the growth plate from the Achilles tendon is often a good idea. Occasionally foot orthotics are used for calcaneal apophysitis and they have been shown to be quite helpful.
This approach will typically manage most cases of calcaneal apophysitis, especially the understanding the nature of the condition and the management of the loads. On a rare occasion some children may be put in walking braces or lower limb casts to deal with the symptoms and as a means to reduce the amount of physical activity. This management of the loads may be an ongoing strategy until the growth of the heel bone stops and that growth plate merges with the rest of the heel bone.
