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What Are The Causes Of Calcaneal Apophysitis?


Sever?s Disease (calcaneal aphophysitis) is not really a disease, but more a repetitious strain injury. This is the most common cause of kids heel pain seen at Podiatry Care. Active children in football, soccer, basketball, netball and tennis with this type of foot pain complain of pain in the region of the heel bone particularly after exercise. In severe cases, children will complain of pain during exercise as well. It is a frequent cause of heel pain in children, particularly in the very active child. It is most often seen in children between the ages of 8 to 15 years as the growth plate is not fully developed or calcified at this time.


Severs disease is caused by repetitive excessive force to the growing area of the heel bone, causing injury to this area. The calf muscles (soleus and gastrocnemius) are attached by the Achilles tendon to the calcaneus (heel bone). They exert a huge force during running , jumping and landing. In children, there is a growing area in the heel bone called the apophysis and is made of relatively weak cartilage. If there is excessive force at this relatively weak point damage occurs. This excess force can be caused by a number of factors. During the adolescent growth spurt the bones grow very quickly. The muscles do not grow out at the same rate as the bone grows and so can become very tight. The calf muscles generate huge forces when they are used to run, jump and land. This force is transmitted to the calcaneal apophysis (growth area). The gastrocnemius muscle spans both the ankle and knee joint. Tightness of this or any other muscles of the lower limb (hamstring or quadriceps) cause extra force at the growing (weak) area. In active children, who undertake a lot of exercise, the repetitive high force causes damage. If your child has poor biomechanics due to poor lower limb alignment (often caused by flat feet), the muscles of the lower limb have to work excessively hard and this can cause increased force at the tibial tubercle.


Athletes with Sever?s disease are typically aged 9 to 13 years and participate in running or jumping sports such as soccer, football, basketball, baseball, and gymnastics. The typical complaint is heel pain that develops slowly and occurs with activity. The pain is usually described like a bruise. There is rarely swelling or visible bruising. The pain is usually worse with running in cleats or shoes that have limited heel lift, cushion, and arch support. The pain usually goes away with rest and rarely occurs with low-impact sports such as bicycling, skating, or swimming.


A Podiatrist can easily evaluate your child?s feet, to identify if a problem exists. Through testing the muscular flexibility. If there is a problem, a treatment plan can be create to address the issue. At the initial treatment to control movement or to support the area we may use temporary padding and strapping and depending on how successful the treatment is, a long-term treatment plan will be arranged. This long-term treatment plan may or may not involve heel raises, foot supports, muscle strengthening and or stretching.

Non Surgical Treatment

* Cold packs: Apply ice or cold packs to the back of the heels for around 15 minutes after any physical activity, including walking.

* Shoe inserts: Small heel inserts worn inside the shoes can take some of the traction pressure off the Achilles tendons. This will only be required in the short term.

* Medication: Pain-relieving medication may help in extreme cases, but should always be combined with other treatment and following consultation with your doctor).

* Anti-inflammatory creams: Also an effective management tool.

* Splinting or casting: In severe cases, it may be necessary to immobilise the lower leg using a splint or cast, but this is rare.

* Time: Generally the pain will ease in one to two weeks, although there may be flare-ups from time to time.

* Correction of any biomechanical issues: A physiotherapist can identify and discuss any biomechanical issues that may cause or worsen the condition.

* Education: Education on how to self-manage the symptoms and flare-ups of Sever?s disease is an essential part of the treatment.