If your young son or daughter complains of a persistent pain in the heel of the foot, there's a good chance that it might be calcaneal apophysitis, otherwise known as Sever's Disease. Sever's Disease is a very common occurrence in kids, often beginning when children are 8 to 10 years old. This article gives a quick overview of Sever's Disease and offers tips and treatments that work.
Disclaimer: This article is compilation of my research as a parent whose child had Sever’s Disease. The information in this article is not a substitute for medical advice.
What is Sever’s Disease and Why Does it Cause Heel Pain?
Sever’s disease is a bone disorder that occurs when the heel bone (growth plate) becomes inflamed. This growth plate is part of the foot’s bone-growing process, where cartilage turns in to bone. The growth plate will expand and eventually harden, fusing with the growing heel bone. 
In some children, a growth spurt causes the heel bone to grow at a faster rate than leg muscles and tendons, leading to overstretching and tightness. When this happens, the heel becomes less flexible and pressure is placed on the growth plate.
Because the Achilles tendon is the strongest tendon connected to the heel’s growth plate, stress on this tendon can lead to Achilles heel pain. The stress overtime to the foot results in growth plate damage – inflammation, tenderness, and pain. 
The bad news is that Sever’s Disease is painful and can last a couple of weeks to several months. Indeed, when a foot injury sidelines a child from a favorite sport, the hiatus can feel like a lifetime.
However, the good news is that while its name sounds frightening, Sever’s disease does not lead to any long-term effects.
Who Gets Sever's Disease?
Because Sever’s disease usually occurs at the onset of a growth spurt, the disease affects girls between 8 and 13 years of age and boys between 10 and 15. The heel bone usually done growing by the time a child turns 15.
Sever’s disease is not the only cause of heel pain in kids, but it is very common, especially in growing children who participate in physical activities, such as sports that involve running and jumping. Sports that place stress on the foot that results in Sever’s-related Achilles heel pain include basketball, soccer, track, gymnastics and dance. Note that these are sports that usually take place on hard surfaces, and are sports that in some cases require little or no footwear (gymnastics and dance).
Sometimes standing too long can put too much pressure on the heel. Wearing shoes that don’t fit well or that don’t provide adequate support or padding can also contribute to the heel pain.
Certain conditions that place stress on the growth plate and that shorten the Achilles tendon can make a child more prone to Sever’s Disease. These conditions include having a pronated foot (an arch that falls inward when walking), having a high or flat arch, having one leg shorter than the other, or being overweight or obese.
What are the Symptoms of Sever's Disorder?
In addition to your child’s complaints about heel pain that feels like a bruise, you might notice that your child has difficulty walking, or is walking on tiptoes or with a limp so as not to place pressure on the heels.
In addition, you might notice that your child feels the heel pain following physical activity, or feels pain or stiffness upon waking in the morning. Also, there might be redness or swelling at the heel area, and pain when the heel is squeezed.
Tips and Treatment for Sever’s Disease
First, check with a doctor. After you describe the symptoms, the doctor may take a x-ray to rule out any other condition like fractures or a bone cyst.
There are different approaches to Sever's Disease treatment, depending on your child's activity and severity of the pain. However, the main treatment for Sever’s Disease is to rest the feet, avoiding any activity that is causing the heel pain.
Understandably, for children in competitive sports or even those in recreation sports who love to play, that’s a tough thing to do. Here some tips to keep in mind:
- The sooner the Sever's Disease treatment, the faster the recovery. Severe cases might require a cast to immobilize the foot for several weeks or months to allow it to heal.
- If possible, go directly to a sports medicine doctor for treatment. In my daughter’s case, we went to her pediatrician and then received a referral to a sports medicine doctor. We could have skipped the first step.
- An alternative to stopping all sports activities is to switch your child to a low-impact activity such as swimming or bicycling. These activities will still allow for conditioning without aggravating the foot injury.
- Be strategic in the activities you choose to temporarily suspend. For example, my daughter is a recreational gymnast at the advanced level. Because it would be difficult, if not dangerous, for her to execute back hand-springs (back flips), she decided to rest from gymnastics class. However, she continues to take dance classes. Modifying her footwear (described below) and carefully selecting dance movements have helped her to minimize heel pain.
- Done under a doctor's care, foot and leg exercises -- particularly calf stretches against a wall or table – can help to stretch leg muscles and tendons. As the doctor in the video advises, it is helpful to apply heat to the calves before stretching and then ice afterward.
- Applying ice to the heel area for 20 minutes several times a day can help ease the pain. A good way to ice the feet is to pick a bag or two of your favorite small frozen vegetable -- such as peas -- to use as an ice pack. The bag of vegetables will mold nicely to the heel area. Moreover, using a bag of frozen peas as an ice pack is reusable, and the peas won’t melt into a liquid like ice.
- The best method for icing the foot to treat heel pain is to use a cold water bath. Take a small 7 or 10 gallon trash can filled with water. Add a little ice to lower the temperature. Note that the water does not have to be freezing. Although a little more labor intensive method of icing, this method allows for the entire lower legs to be iced as well. Swimming pools also work well for soaking the feet if you have access to one.
- It is important to consistently ice the injured heel area even when pain is not severe.
- Use over the counter anti-inflammatory pain medication like ibuprofen (Motrin, Advil).
- Wearing proper shoes is important. Buy good quality shoes that fit well. Open backed shoes like clogs might also help because they will not rub against the injured heel area.
- If pronation (arch flattening more than normal) is a problem, shoe inserts such as a heel wedge can help, especially in shoes like cleats. Also arch support insoles can also help to support the heel area.
- With activities that do not allow for shoes (gymnastics and dance for example), children can use a special support called the X-brace. The X-brace is an elastic band that slips around the arch area of the foot, with a second connected piece that loops around the heel area. The elastic bands are snug, so it takes some getting used to. However, my daughter was able to continue her dance activities with minimal pain because of it. Here's how to use the X-brace:
Sever's Disease is both a painful and persistent disorder that many young, active children experience. While immediate complete relief may not be possible, the Sever's Disease treatments and tips discussed above may help to reduce the pain.