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Sever’s Disease

    • Sever’s Disease, also known as calcaneal apophysitis, is the most common cause of heel pain in children and adolescents (Fares et al, 2021). The Achilles tendon, which runs along the backside of the ankle, connects the calf muscle to the heel bone. With physically active, growing children the Achilles becomes tight and begins pulling on its insertion point on the growth plate of the heel bone. The growth plate is a soft area of cartilage near the end of the bone where bone growth occurs. This repetitive stress on the growth plate from this pulling leads to inflammation and pain of the heel.

    • Symptoms of Sever’s Disease may include redness, swelling and irritation over the back of the heel, impaired gait or limping during walking or running. Pain may be reported in one or both heels. Typically, symptoms are more gradual in onset and not associated with a specific injury.

    • 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. X-ray imaging may be utilized to rule out similarly presenting conditions.

    • Conservative Management
      • Sever’s Disease is managed through conservative measures including rest, activity modification, ice, NSAIDs, and physical therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for pain relief and physical therapy may be utilized to improve strength and flexibility and restore function of the injured area. Orthotic devices may also be utilized to relieve pain over the affected area.

Fares MY, Salhab HA, Khachfe HH, Fares J, Haidar R, Musharrafieh U. Sever's Disease of the Pediatric Population: Clinical, Pathologic, and Therapeutic Considerations. Clin Med Res. 2021 Sep;19(3):132-137. doi: 10.3121/cmr.2021.1639. PMID: 34531270; PMCID: PMC8445662.