Sever's disease (calcaneal apophysitis) is an inflammatory condition that affects the heel bone (calcaneus). It happens frequently in young athletes between the ages of 10 and 13, causing pain in one
or both heels when walking. Tenderness and swelling may also be present. Similar to another overuse condition, Osgood-Schlatter disease, Sever's disease has occasionally been termed Osgood-Schlatter
of the heel. In young people, the heel bones are still divided by a layer of cartilage. During the growth years, the bone is growing faster than tendons. This makes it likely that the heel cord will
be applying great tension where it inserts into the heel bone. In addition, the heel cord is attached to an immature portion of the heel bone, the calcaneal apophysis. In young athletes, the
repetitive stress of running and jumping while playing soccer and basketball may cause an inflammation of the growth center of the heel.
There are several causes of heel pain in the young athletic population with the most common being calcaneal apophysitis (also referred to as Sever?s disease). Sever first reported calcaneal
apophysitis in 1912 as an inflammation of the apophysis, causing discomfort to the heel, mild swelling and difficulty walking in growing children. The condition usually manifests between the ages of
8 and 14 with a higher incidence in boys than girls. In reality, however, calcaneal apophysitis is being diagnosed more frequently in girls due to their increase in participating in sports such as
soccer, basketball and softball.
Most children with Sever's complain of pain in the heel that occurs during or after activity (typically running or jumping) and is usually relieved by rest. The pain may be worse when wearing cleats.
Sixty percent of children's with Sever's report experiencing pain in both heels.
Physical examination varies depending on the severity and length of involvement. Bilateral involvement is present in approximately 60% of cases. Most patients experience pain with deep palpation at
the Achilles insertion and pain when performing active toe raises. Forced dorsiflexion of the ankle also proves uncomfortable and is relieved with passive equinus positioning. Swelling may be present
but usually is mild. In long-standing cases, the child may have calcaneal enlargement.
Non Surgical Treatment
There are several things we can do to treat Sever?s disease and ease the discomfort. Special shoe inserts, such as heel pads or cups, can act as a shock absorber, decrease pressure on the heel bone
and slightly elevate the heel to relieve the pain. Elastic wraps and compression stockings can help decrease any swelling and pain. We also show kids some specific stretches that can help stretch the
calf muscles and tendons on the back of the leg to reduce stress on the heel. We might also recommend rest, applying ice, elevating the foot, and over-the-counter pain medication.
With proper care, your child should feel better within 2 weeks to 2 months. Your child can start playing sports again only when the heel pain is gone. Your doctor will let you know when physical
activity is safe.