Diagnosis: Sever’s Disease
Sever’s disease, also called calcaneal apophysitis, is a painful inflammation of the calcaneal apophysis and is the most common cause of heel pain in the growing athlete. The calcaneal growth plate and apophysis are surrounded by the attachments of the calf muscles and plantar fascia to the heel bone, and are exposed to high stress from these structures. This condition frequently occurs before or during the peak growth spurt and often shortly after a child begins a new sport or season. It is most common in boys 10-12 years old and frequently in girls 8-10 years old who are active in sports.
How Sever’s Disease Presents
Typically, patients complain of pain in one or both heels when running and walking. The pain is localised to the point on the heel where the Achilles tendon inserts into the calcaneus. The heel is tender to deep pressure at the site, and squeezing the posterior aspect of the heel elicits pain. Toe-walking relieves pain. Symptoms of Sever disease can interfere with sports participation for several months.Symptoms of Sever disease can interfere with sports participation for several months. #performbetter @pogophysio Click To Tweet
How Sever’s Disease is Diagnosed
Compression of the medial and lateral aspects of the heel usually reveals tenderness. A positive squeeze test in a child or adolescent with heel pain but no other signs and symptoms, such as red skin or swelling, almost always indicates a diagnosis of Sever’s disease. Sometimes X-Rays will be requested to rule out other conditions such as calcaneal stress fractures, bone cysts or presences of foreign bodies. This may also be indicated if adequate treatment has been delivers however the pain still persists.
Causes of Sever’s Disease
There are a number of proposed causes of this disease:
- Repetitive microtrauma to the calcaneus from the pull of the Achilles tendon on the unossified apophysis.
- Strain caused by hard strikes to the heels in children with high arches or with flat feet.
- Mechanical disruption caused by recurring microtrauma.
Treatment of Sever’s Disease
There are many treatment options effective for Sever’s disease. Suggestions include:
- Limiting sporting activities to reduce pain and discomfort, prevent the return of symptoms, and allow for recovery.
- Ice, heat or ultrasound to manage severe pain and inflammation.
- As symptoms subside, physiotherapists can work on flexibility, strength and muscle balance. This may include:
- Gastrocnemius and soleus stretching.
- Dorsiflexion strengthening.
- Stretching the hamstring and quadriceps muscles to reduce tension in the Achilles tendon.
- Orthotics, or heel cushioning, which decrease the pressure on the calcaneus and relaxes the Achilles tendon.
- Taping the heel if orthotics is unsuitable.
- Short-term application of a short-leg cast to force the heel into a resting position, and reduce pain and inflammation, when symptoms persist. The cast is usually worn for between two and three weeks, and the foot can be cast in mild. Use of non-steroidal anti-inflammatory drugs to decrease pain and swelling.
Hendrix, C. L. (2005). Calcaneal apophysitis (Sever disease). Clinics in podiatric medicine and surgery, 22(1), 55-62.
Howard, R. (2014). Diagnosing and treating Sever’s disease in children: Ruth Howard explains why young people who take part in physical activities can experience posterior heel pain and how the condition can be managed. Emergency Nurse, 22(5), 28-30.
Micheli, L. J., & Ireland, M. L. (1987). Prevention and management of calcaneal apophysitis in children: an overuse syndrome. Journal of Pediatric Orthopaedics, 7(1), 34-38.