London Foot Pain Clinic, 1 St Andrews Close, Wimbledon, SW19 8NJ
Sever’s disease, also known as calcaneal apophysitis, is one of the most common causes of heel pain in children, particularly those aged 8-15 who are active in sports. Understandably, as a parent, seeing your child in pain can be distressing, and you might wonder whether imaging such as X-rays or MRI can definitively rule out this condition. At the London Foot Pain Clinic, we frequently encounter this question and aim to clarify Sever’s disease and the role of scans in its diagnosis.
What is Sever’s Disease?
Sever’s disease occurs when the growth plate in the heel becomes inflamed due to repetitive stress or tension on the Achilles tendon. This condition is prevalent in children during growth spurts when their bones grow faster than their muscles and tendons, leading to tightness and increased strain on the heel.
Typical symptoms include:
- Pain or tenderness at the back or bottom of the heel.
- Swelling or redness in the heel area.
- Pain that worsens during activity and improves with rest.
- Limping or walking on toes to avoid putting pressure on the heel.
Is a Scan Necessary for Diagnosing Sever’s Disease?
In most cases, Sever’s disease is diagnosed clinically based on the child’s symptoms, medical history, and physical examination. Imaging is rarely required because the condition does not appear well on standard scans like X-rays. Growth plate changes seen on imaging may be expected for the child’s age and not necessarily indicative of Sever’s disease.
However, scans may be considered in specific cases to rule out other conditions, such as:
- Fractures
- Tumors
- Infections
- Rare congenital abnormalities
We use imaging sparingly and only when necessary at the London Foot Pain Clinic. Suppose your child’s symptoms are atypical or persistent despite initial treatment. In that case, we may recommend further investigation using ultrasound or MRI, as these can provide a more detailed view of soft tissues and inflammation than X-rays.
Why Clinical Diagnosis Matters
Sever’s disease is fundamentally a growth-related condition, meaning identifying it involves assessing your child’s activity level, growth stage, and typical movement patterns. Relying solely on scans can be misleading, as imaging findings often overlap with what is considered normal in children of the same age group.
Our diagnostic process includes:
- Detailed Medical History: Understanding your child’s activities, sports involvement, and growth patterns.
- Physical Examination: Assessing the heel’s tenderness, swelling, and response to specific tests such as the squeeze test.
- Gait Analysis: Observe how your child walks and whether biomechanical issues contribute to the pain.
How We Manage Sever’s Disease
Treatment for Sever’s disease focuses on reducing pain, relieving tension on the growth plate, and allowing the heel to heal as your child grows. At the London Foot Pain Clinic, we offer a comprehensive approach, including:
- Custom Orthotics: To redistribute pressure and reduce strain on the heel.
- Activity Modification: Advising rest or reducing high-impact activities.
- Stretching and Strengthening Exercises: To improve flexibility and support the Achilles tendon and surrounding muscles.
- Heel Pads or Taping Techniques: To cushion the heel and improve alignment.
- Focused Shockwave Therapy: For persistent cases, typically at the clinic, this child hasn't naturally healed within 4-6 weeks of conservative therapy. We use non-invasive shockwave therapy above and below the growth plate to promote healing and reduce inflammation. The results are mind-blowing and compelling; you can see considerable changes in as little as two weeks. The older radial types of devices were much more painful, so we would often wait longer before starting shock wave therapy. However, the treatment is relatively painless with the new focused devices, so there is no need to wait.
When to Consider a Scan in suspected Sever's disease
A scan may be warranted if your child’s heel pain does not improve with initial treatments or if their symptoms are unusual (e.g., significant swelling, pain at rest, or systemic symptoms like fever). At our clinic, we collaborate with local imaging centres for quick access to ultrasound, X-ray, or MRI when needed, ensuring a thorough assessment while avoiding unnecessary procedures.
Take the First Step Toward Recovery
Sever’s disease can be painful, but it is also temporary and self-limiting as the growth plate matures. Early intervention and proper management can help your child return to their favourite activities pain-free.
If you suspect your child has severe disease or are concerned about heel pain, contact us at the London Foot Pain Clinic, 1 St Andrews Close, Wimbledon, SW19 8NJ. You can call us at 020 8540 3389 or email us at