Sever's Disease

What is it?

Sever’s Disease or calcaneal apophysitis is a condition that affects the calcaneus in children. It was previously thought to be an enlargement of the epiphyseal line of the calcaneus but is now known to be an inflammation of the calcaneal apophysitis, the cartilaginous growth centre to which the achilles tendon attaches. Repetitive strain and microtrauma caused by the force of a strong achilles and results in irritation and potential avulsion of the relatively soft calcaneal apophysis. This condition is typically seen in children between the ages of 8-15yrs in either the very active or overweight, and is reported in 2-16% of cases in sports clinics.

 

Common signs and symptoms:

  • Pain with walking and when playing sports is very common, particularly those that involve jumping and running for example track and field, soccer and gymnastics.

  • Limping following sport 

  • Reduced dorsiflexion

  • Bilateral heel pain in 60% of cases

  • Some correlation with periods of rapid growth

 

Common causes:

There is no known direct cause of Sever’s disease however, it is thought to be resultant of traction in opposite directions between the achilles tendon, plantar fascia and aponeurosis. Contributing factors include heel cord tightness, weak dorsiflexion, worn out or poor-fitting shoes and repetitive running and jumping on hard surfaces.

 

Prognosis:

Prognosis for Sever’s disease is excellent. There is a high recurrence rate of Severs disease however, if proper treatment is sort, no symptoms or pain will be expected after closure of the apophysis.

 

Treatment options:

  • Rest 

  • Taping for medial arch support

  • Stretching of tight achilles tendon, gastrocnemius and soleus muscles

  • Strengthening of all muscles that move the ankle

  • Mobilisation

  • Heel lifts

  • Orthoses

  • Support and cushioning in shoes 

  • Immobilisation and casting in severe cases

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Reference

1) James, A. M., Williams, C. M., & Haines, T. P. (2013). Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever’s disease): a systematic review. Journal of foot and ankle research, 6(1), 16.

2) Scharfbillig, R. W., Jones, S., & Scutter, S. D. (2008). Sever’s disease: what does the literature really tell us?. Journal of the American Podiatric Medical Association, 98(3), 212-223.

3) Smith, J. M., & Varacallo, M. (2019). Sever's Disease.

4) Hunt, G. C., Stowell, T., Alnwick, G. M., & Evans, S. (2007). Arch taping as a symptomatic treatment in patients with Sever's disease: a multiple case series. The foot, 17(4), 178-183.