Sever's disease or calcaneal apophysitis heel pain is a common problem with children between the ages of 8 to 13 years. It has usually been more common in boys, but with the increase of girls in
athletic activities, both sexes are having equal symptoms. A high percentage of these children have tight achilles tendons and hamstrings. This condition may occur in the foot with normal arch height
or flat or pronated foot, but can be especially painful in the high arch foot.
A big tendon called the Achilles tendon joins the calf muscle at the back of the leg to the heel. Sever?s disease is thought to occur because of a mismatch in growth of the calf bones to the calf
muscle and Achilles tendon. If the bones grow faster than the muscles, the Achilles tendon that attaches the muscle to the heel gets tight. At the same time, until the cartilage of the calcaneum is
ossified (turned into bone), it is a potential weak spot. The tight calf muscle and Achilles tendon cause a traction injury on this weak spot, resulting in inflammation and pain. Sever?s disease most
commonly affects boys aged ten to 12 years and girls aged nine to 11 years, when growth spurts are beginning. Sever?s disease heals itself with time, so it is known as ?self-limiting?. There is no
evidence to suggest that Sever?s disease causes any long-term problems or complications.
Sever?s disease is more common in boys. They tend to have later growth spurts and typically get the condition between the ages of 10 and 15. In girls, it usually happens between 8 and 13. Symptoms
can include pain, swelling, or redness in one or both heels, tenderness and tightness in the back of the heel that feels worse when the area is squeezed. Heel pain that gets worse after running or
jumping, and feels better after rest. The pain may be especially bad at the beginning of a sports season or when wearing hard, stiff shoes like soccer cleats. Trouble walking. Walking or running with
a limp or on tip toes.
Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a "squeeze test" and some other tests to confirm the diagnosis. Some children suffer
Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors
thought to predispose a child to Sever?s disease include decrease ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing activities
Non Surgical Treatment
Most patients with Sever?s Disease can be treated with a self-guided home exercise program. Your healthcare provider will discuss with you if a prescription for formal physical therapy is indicated
instead of a self-directed home or school exercise program. Rest (protection of the heel). Ice (Ice 20 minutes at a time, 2-3 times a day). Gel heel pads / inserts. Anti-inflammatory medication. Well
cushioned pair of shoes. Brace (Cheetah) *Generally given for those who cannot wear shoes during their sport. Low impact aerobic training such as walking, riding a bike, elliptical or swimming. Home
exercise program focusing on increasing the flexibility of the heel cord and calf muscle.
This condition is self limiting - it will go away when the two parts of bony growth join together - this is natural. Unfortunately, Sever's disease can be very painful and limit sport activity of the
child while waiting for it to go away, so treatment is often advised to help relieve it. In a few cases of Sever's disease, the treatment is not successful and these children will be restricted in
their activity levels until the two growth areas join - usually around the age of 16 years. There are no known long term complications associated with Sever's disease.