Sever’s disease (also known as calcaneal apophysitis) is one of the most common causes of heel pain in growing children, especially children who are very physically active. It is an inflammation of the growth plate in the calcaneus (heel). Sever’s disease is caused by repetitive stress to the heel. It most often occurs during growth spurts, when bones, muscles, tendons, and other structures are changing rapidly. In most cases of Sever’s disease, simple measures like rest, over-the-counter medication, and a change in footwear will relieve pain and allow a return to daily activities. In addition, stretching the calf muscles may help decrease the stress on the heel. The bones of children and adolescents possess a special area where the bone is growing called the growth plate. Growth plates are areas of cartilage located near the ends of bones. When a child is fully grown, the growth plates close and are replaced by solid bone. Until this occurs, the growth plates are weaker than the nearby tendons and ligaments and are vulnerable to trauma. Sever’s disease affects the part of the growth plate at the back of the heel. This growth area serves as the attachment point for the Achilles tendon — the strong band of tissue that connects the calf muscles at the back of the leg to the heel bone. Repetitive stress from running, jumping, and other high-impact activities can cause pain and inflammation in this growth area of the heel. Additional stress from the pulling of the Achilles tendon at its attachment point can sometimes further irritate the area. Painful symptoms are often brought on by running, jumping, and other sports-related activities. In some cases, both heels have symptoms, although one heel may be worse than the other. Symptoms may include:
During the appointment, your child's doctor will:
Treatment for Sever’s disease focuses on reducing pain and swelling. This typically requires limiting exercise activity until your child can enjoy activity without discomfort or significant pain afterwards. In some cases, rest from activity is required for several months, followed by a strength conditioning program. However, if your child does not have a large amount of pain or a limp, participation in sports may be safe to continue. Your child's doctor may recommend additional treatment methods, including:
In cases where the pain is bad enough to interfere with walking, a “walker boot” might be required to immobilize the foot while it heals. It is not unusual for Sever’s disease to recur. This typically happens when a child once again increases sports activities. Wearing sports shoes that provide good support to the foot and heel may help prevent recurrence. Sever’s disease will not return once a child is fully grown and the growth plate in the heel has matured into solid bone. Original Editor - Tassignon Bruno Top Contributors - Tassignon Bruno, Wanda van Niekerk, Kim Jackson, , Keta Parikh, Arnold Fredrick D'Souza, Admin, Rucha Gadgil, Rachael Lowe, Vidya Acharya, Claire Knott, Meaghan Rieke, Shreya Pavaskar, Maarten Cnuddeand Naomi O'ReillyDefinition/Description[edit | edit source] The term was coined by James Warren Sever in 1912. One of the most common causes of heel pain among children between the ages of 10 to 12 years. Also known as calcaneal apophysitis or calcaneoapophysitis, this condition is the painful inflammation of the calcaneal
apophysis caused by repetitive microtrauma on the unossified apophysis due to traction of the achilles tendon. Other common traction injuries are Iliac apophysitis, medial epicondyle apophysitis or Little League elbow, inferior pole of
patella apophysitis or Sinding-Larsen-Johansson syndrome, tibial tubercle apophysitis or Osgood-Schlatter disease, and fifth metatarsal apophysitis. Clinically Relevant Anatomy[edit | edit source]Apophysis have a higher composition of fibrocartilage. The calcaneal apophysis usually appears in children around 7-9 years old and ossifies as an independent ossification center by around age 15-17 years. The Achilles Tendon inserts to the lower, posterior and slightly medial aspect of the calcaneus. The calcaneal growth plates are subjected to high stress from the plantar aponeurosis and the achilles tendon.[1] Etiology/Risk Factors[edit | edit source]Sever’s disease is an osteochondrosis caused by overload. This C-shaped growth zone becomes inflamed secondary to repetitive traction stress of the achilles tendon. Risk factors may include:
Epidemiology[edit | edit source]Sever's disease is an overgrowth syndrome similar to Osgood-Schlatter disease. Growth is directly proportional to the amount of stress placed on the calcaneal growth plates. Active children and adolescents, particularly during the pubertal growth spurt or at the beginning of a sport season (e.g. gymnasts, basketball and football players) often suffer from this condition[4][5]. This disease occurs most commonly during the early part of the growth spurt. A boy-to-girl ratio is 2-3:1.[5] It occurs only in the growing children and never occurs after puberty[6]. Characteristics/Clinical Presentation[edit | edit source]This syndrome can occur unilaterally or
bilaterally[7]. The incidence of bilaterally is approximately 60%[2].
Differential Diagnoses[edit | edit source]Posterior heel pain can occur due to
Diagnostic Procedures[edit | edit source]Radiography[edit | edit source]Most of the time radiographs are not helpful because the calcaneal apophysis is frequently fragmented and dense in normal children. But they can be used to exclude other traumas. Ultrasonography[edit | edit source]Diagnostic Ultrasound could show the fragmentation of secondary nucleus of ossification of the calcaneal growth plate. This is a safe diagnostic tool since there is no radiation. This diagnostic tool can also be used to exclude Achilles tendinopathy and/or retrocalcaneal bursitis[8]. MRI[edit | edit source]MRI showed signal changes in posterior calcaneal epiphysis, and can help localize inflammation to apophysis[9]. Examination[edit | edit source]
Physical Therapy Management[edit | edit source]As the condition is self-limiting, it resolves as the child matures. Treatment depends on the severity of the child’s symptoms. During the active phase, the patient’s activity level should be limited only by pain. Treatment:
Symptoms usually resolve in a few weeks to 2 months after therapy is initiated[4][5][7]. Resources[edit | edit source][11] References[edit | edit source]
Is severs the same as plantar fasciitis?The symptoms of Sever's disease are similar to those of plantar fasciitis or shin splints, but the conditions aren't related. Symptoms of Sever's disease include: Pain in one heel or both heels (most children report pain in both heels).
How do you know if you have Severs disease?The most common symptom of Sever's disease is pain or tenderness in the back of one or both of the heels. The pain usually occurs at the back of the heel, but it can also extend to the sides and bottom of the heel.
How long can Severs disease last?How long does Sever's disease last? Typically 2-3 months. However, symptoms can last longer in some individuals and can recur over several years.
What happens if you don't treat Sever's disease?In most cases, Sever's disease goes away on its own with rest, treatment, and time. Symptoms may worsen if your child tries to play through the pain or if proper treatment is not followed. Your child may increase activity when symptoms have subsided. Sever's is a disease, however, that can come and go.
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Difference between severs disease and plantar fasciitis
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