Sever’s Disease, also known as calcaneal apophysitis, is a common cause of heel pain in children and adolescents [Fares et al, 2021].
The Achilles tendon RUN along the backside of the ankle connecting the calf muscle to the heel bone, and Sever's disease is due to the repetitive microtrauma to the growth plate due to the pull of the Achilles tendon during activities.
This repetitive stress leads to inflammation and pain at the site of the apophysis.
Factors such as rapid growth, tight or inflexible muscle-tendon units, and high levels of physical activity contribute to the development of Sever's disease [Madden & Mellion, 1996; Nieto-Gil et al, 2023; Becerro-de-Bengoa-Vallejo et al, 2014].
Clinically, Sever's disease presents with heel pain that is often exacerbated by physical activity, especially running and jumping.
Typically, symptoms are more gradual in onset and not associated with a specific injury [Madden & Mellion, 1996].
Diagnosis of Sever’s Disease is based on detailed history, physical examination, and imaging. Certain physical tests may be utilized to reproduce symptoms around the heel and measure range of motion of the foot and ankle at time of exam.
Conservative Management
Sever’s Disease is typically managed through conservative measures including rest, activity modification, ice, NSAIDs, and physical therapy.
Orthotic devices, including heel lifts, may also be utilized to relieve pain over the affected area [Madden & Mellion, 1996].
The condition usually resolves within a few weeks to months with appropriate management. In more severe cases, temporary immobilization may be required [Ogden et al, 2004].
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