Sever?s disease, also referred to as calcaneal apophysitis, is an injury in the growth plate of the lower part of the heel bone where the Achilles tendon attaches to the bone. Sever?s disease is a
common condition affecting children between the ages of 8 and 15 that participate in sports or are particularly active. This condition is believed to be caused by repeated trauma to the heel,
weakening its internal structure. Typically occurring in adolescence, Sever?s disease causes painful inflammation of the growth plate. This condition can affect any child, however there is a higher
probability of its occurrence if the child experiences pronation, has flat or high arches, short leg syndrome and/or is overweight.
With early puberty, the growth plate at the end of the heel develops, transforming cartilage cells into bone cells. This painful heel condition occurs during these growth spurts, when the heel bone
grows more rapidly than the muscles and tendons of the leg. The discrepancy between rates of development causes excess pressure and tension to be placed upon the heel and it becomes less flexible.
This condition affects active children the most. Due to the amount of exercise, more stress is placed upon the tendons which in turn causes more damage to the growth plate. The bone plates fully
mature and harden by the time a child reaches the age of 15.
On examination, the typical signs are tenderness on palpation of the heel, particularly on deep palpation at the Achilles tendon insertion. Pain on dorsiflexion of the ankle, particularly when doing
active toe raises; forced dorsiflexion of the ankle is also uncomfortable. Swelling of the heel, usually mild. Calcaneal enlargement, in long-standing cases.
In Sever's disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or
she runs or jumps. He or she may have a tendency to tiptoe. Your child's heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your doctor may also find that
your child's heel tendons have become tight.
Non Surgical Treatment
Home treatment consists of calf muscle stretching exercises, heel cushions in the shoes, and/or oral anti-inflammatory medications like Tylenol or Advil. Icing the area may provide some temporary
relief. If the condition persists the child should be evaluated by a podiatrist for abnormal foot function. In severe cases a below the knee walking cast may be required. Treatment may require the
use of custom-made shoe inserts called orthotics. Orthotics work by correcting foot function and will fit into most normal shoes and athletic cleats.
It may take several weeks or months for the pain to completely stop. In most cases severs disease goes away on its own with a little rest and time. However if you ignore the pain and play through it,
the condition may get worse and may be more difficult to treat. When the pain is completely gone, you can slowly return to your previous level of activity. With future growth spurts the pain may
return therefore keep up with the stretches and follow the advice given.