Sever's Disease, also known as calcaneal apophysitis, is a disease of the growth plate of the bone and is characterized by pain in the heel of a child's foot, typically brought on by some form of
injury or trauma. This condition is most common in children ages 10 to 15 and is frequently seen in active soccer, football, or baseball players. Sport shoes with cleats are also known to aggravate
the condition. The disease mimics Achilles tendonitis, an inflammation of the tendon attached to the back of the heel. A tight Achilles tendon contributes to Sever's Disease by pulling excessively on
the growth plate of the heel bone (calcaneus). Treatment includes cutting back on sports activities, calf muscle stretching exercises, heel cushions in the shoes, icing, and/or anti-inflammatory
medications. Note: Please consult your physician before taking any medications.
Sever?s Disease is thought to be caused by several reasons. Growth spurts. The muscles and tendons become tight due to rapid bone growth. Overuse. Sever?s Disease can also occur in children who are
athletically active and overwork his or her muscles. Some physicians are beginning to caution parents about checking their children?s shoes to make sure they fit well and do not pinch or put undue
pressure on the child?s feet. Pronation can also bring on Sever?s Disease.
Sharp pain will be present in the affected heel (or both heels), especially while running or walking. Pain can be heightened following activity. The area will be tender to the touch and usually
becomes inflamed or reddened. It may also be painful to press on the heel with a finger from the back or to squeeze the sides together; the latter is particularly common. You might notice stiffness
in some of the surrounding muscles, making regular movements more difficult to achieve. This and the pain can manifest physically in abnormal practices like tiptoeing or limping. In some cases a lump
can be detected on the back of the heel, though it may be so small as to defy detection.
Physical examination varies depending on the severity and length of involvement. Bilateral involvement is present in approximately 60% of cases. Most patients experience pain with deep palpation at
the Achilles insertion and pain when performing active toe raises. Forced dorsiflexion of the ankle also proves uncomfortable and is relieved with passive equinus positioning. Swelling may be present
but usually is mild. In long-standing cases, the child may have calcaneal enlargement.
Non Surgical Treatment
The following are different treatment options. Rest and modify activity. Limit running and high-impact activity to rest the heel and lessen the pain. Choose one running or jumping sport to play at a
time. Substitute low-impact cross-training activities to maintain cardiovascular fitness. This can include biking, swimming, using a stair-climber or elliptical machine, rowing, or inline skating.
Reduce inflammation. Ice for at least 20 minutes after activity or when pain increases. Nonsteroidal anti-inflammatory drugs (NSAIDs) may also help. Stretch the calf. Increase calf flexibility by
doing calf stretches for 30 to 45 seconds several times per day. Protect the heel. The shoe may need to be modified to provide the proper heel lift or arch support. Select a shoe with good arch
support and heel lift if possible. Try heel lifts or heel cups in sports shoes, especially cleats. Try arch support in cleats if flat feet contribute to the problem.
Maintain good flexibility through stretching exercises. Avoid excessive running on hard surfaces. Use quality, well-fitting shoes with firm support and a shock-absorbent sole.