Division of Pediatric Orthopaedics
Sanjeev Sabharwal, MD
Tamir Bloom, MD
Emily McClemens, PA-C Michele Edgar, PA-C
Phone: (973) 972-0246
Sever’s Apophysitis (Calcaneal apophysitis):
Frequently Asked Questions
What is Sever’s apophysitis? Sever’s apophysitis ( a·poph·y·si·tisis) a common
cause of heel pain in growing children. It is a condition where the Achilles’
tendon (heel cord) on the back of the ankle pulls on the heel. This causes
irritation of the growth plate on the heel bone. Rarely, there can be an
avulsion fracture when a small piece of the bone is pulled away from the
rest of the heel. About 60% of children will have it in both heels. It may last
from a few months to two years. It can be very painful with activity and it
will feel better with rest.
Achilles tendon (heel cord)
Apophysis (growth plate)
What causes it?
Calcaneus (heel bone)
This is usually an overuse type of injury that gets worse during growth
spurts. It is most common between the ages of 8 to 12 years old. It can
happen when your child increases activity, like running and jumping. It is
more common in people with tight heel cords.
How does this affect my child?
This condition causes pain with activity. It may limit your child’s ability to
participate fully in their sport. When left untreated, the pain may limit
simple activities of daily life.
What tests might be done?
Often no tests are needed. X-rays are sometimes done.
How is it treated?
It is treated by stopping or limiting activity that causes pain. Do stretching
exercises for the heel cord and hamstrings (see attached exercise sheet).
Strengthening and balance exercises can be done once pain is better and to
try to limit more pain.
 Icing the heel after activity can help reduce inflammation
and discomfort. Here’s how icing the heel is done.
1. Sit down on a chair or couch and put your heel up in a relaxed
position.
2. Take a ready made ice pack, plastic bag full of ice (wrapped in a
towel, not applied directly to the skin) or a package of frozen peas or
corn and cover it with a light towel or cloth.
3. Use an elastic wrap or compression stocking to hold ice pack in
place over the heel that is hurting.
4. Keep it on for 10-15 minutes, two or three times per day, even on
days when the pain is not that bad, to help reduce swelling.
5. Replace cold pack in the freezer.
6. Don't eat the frozen vegetables once they are used for icing.
 Take an over-the-counter medicine to reduce pain and swelling, such
as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin, Nuprin).
 Using a shoe insert or heel cushion. These are available at most
sporting goods stores and drug stores.
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When can my child return to activity?
Most young athletes can play through a low level of pain without doing any
damage. However, playing through moderate or severe pain can worsen the
condition and make it more difficult to treat. Severe pain will also change
the way your child uses their leg muscles, which can increase the risk for
other leg injuries. The doctor will help you decide when and how you can get
your child safely back up to full activity.
Recovery and Recurrence
One of the most important things to know about Sever's disease is that,
with proper care, the condition usually goes away within 2 weeks to 2
months and does not cause any problems later in life. The sooner Sever's
disease is addressed, the quicker recovery is. Most kids can return to
physical activity without any trouble once the pain and other symptoms
go away.
Although Sever's disease generally heals quickly, it can recur if long-term
measures are not taken to protect the heel during a child's growing years.
One of the most important is to make sure that kids wear proper shoes.
Good quality, well-fitting shoes with shock-absorbent (padded) soles help
to reduce pressure on the heel. The doctor may also recommend shoes
with open backs, such as sandals or clogs, that do not rub on the back of
the heel. Shoes that are heavy or have high heels should be avoided.
Other preventive measures include continued stretching exercises and
icing of the affected heel after activity.
If your child is overweight or obese, we also recommend weight loss to
decrease pressure on the heel.
The risk of recurrence goes away on its own when foot growth is complete
and the growth plate has fused to the rest of the heel bone, usually around
age 15 years.
What follow-up care might be needed?
Your doctor should check you in 4-6 weeks. You may need to be seen more
often if you have pain and limited function.
ALERT: Call your child’s doctor, nurse, or clinic if you have
any questions or concerns or if your child:
 Has worsening or steady pain that is not helped by pain medicine. Has
more swelling or bruising. Is having a harder time walking or running. Has
special health care needs that were not covered by this information.
Useful websites:
American Academy of Orthopaedic Surgeons: www.aaos.org
American Academy of Family Physicians: www.aafp.org
Video animation of exercises:
http://familydoctor.org/familydoctor/en/diseases-conditions/seversdisease/treatment.html
HEEL CORD AND HAMSTRINGS EXERCISES
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