Sever's disease or Calcaneal apophysitis is a condition that affects children between the ages of 10 and 13 years. It is characterized by pain in one or both heels with walking. During this phase of
life, growth of the bone is taking place at a faster rate than the tendons. Hence there is a relative shortening of the heel-cord compared to the leg bones. As a result, the tension the heel-cord
applies to the heel bone at its insertion is very great. Moreover, the heel cord is attached to a portion of the calcaneus (heel bone) that is still immature, consisting of a mixture of bone and
growing cartilage, called the calcaneal apophysis, which is prone to injury. Compounding to this is the fact that all these changes are happening in a very active child, prone to overuse. The end
result is therefore an overuse syndrome of injury and inflammation at the heel where the heel cord (Achilles Tendonitis) inserts into the heel bone (Calcaneal apophysitis).
The cause of Sever's Disease is not entirely clear but it is most likely due to repeated minor trauma that occurs during high-impact activities that involve running and jumping such as soccer,
basketball, and gymnastics. It may also occur when an active child regularly wears shoes with poor heel padding, shock absorbency, or poor arch support. Some additional contributing factors are
excessive pronation, an overly tight calf muscle, and other flaws in the biomechanics of a child's walking stride. Children who are overweight are also at greater risk of developing Sever's
Pain is usually felt at the back and side of the heel bone. Sometimes there may be pain at the bottom of the heel. The pain is usually relieved when the child is not active and becomes painful with
sport. Squeezing the sides of the heel bone is often painful. Running and jumping make the symptoms worse. One or both heels can be affected. In more severe cases, the child may be limping.
You may have pain when your doctor squeezes your heel bone. You may have pain when asked to stand or walk on your toes or on your heels. You may have pain in your heel when your doctor stretches your
calf muscles. Your doctor may order x-rays of the injured foot to show an active growth plate.
Non Surgical Treatment
Physiotherapy treatment to improve range of the ankle and descrease soft tissue tightness. Orthotics to control excessive motion of the foot. Icing the painful area. Use of topical anti-inflammatory
cream. Taping of the foot during exercise. Stretching, only if recommended by the physiotherapist.
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.