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Sever's Disease: Causes, Symptoms & Treatment
Sever's disease is a painful growth disorder of the heel affecting children and adolescents, commonly triggered by physical activity and sports.
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Sever's disease is a painful growth disorder of the heel affecting children and adolescents, commonly triggered by physical activity and sports.
What is Sever's Disease?
Sever's disease, medically known as calcaneal apophysitis, is a growth-related condition of the heel that primarily affects physically active children and adolescents. It involves inflammation of the growth plate (apophysis) of the heel bone (calcaneus), where the Achilles tendon attaches. It is classified as an osteochondrosis and is the most common cause of heel pain in children. The condition is named after American physician James Warren Sever, who first described it in 1912.
Causes
Sever's disease is caused by overuse and repetitive stress on the still-developing growth plate of the heel bone. During growth spurts, the cartilage in this area is particularly vulnerable to mechanical stress.
- Intense sports activity: Football, running, gymnastics, and other high-impact sports significantly increase the risk.
- Growth spurts: During rapid growth phases, the Achilles tendon becomes relatively shorter compared to the bone, placing increased traction on the apophysis.
- Inappropriate footwear: Shoes lacking adequate cushioning or with hard soles amplify heel stress.
- Foot deformities: Flat feet or tight calf muscles can contribute to the onset of symptoms.
- Hard playing surfaces: Training on asphalt or hard courts places greater stress on the heel than softer surfaces.
Symptoms
The symptoms of Sever's disease are usually recognizable and may occur in one or both heels:
- Pain at the back and underside of the heel, especially during running, jumping, or climbing stairs
- Pain that worsens after physical activity and improves with rest
- Tenderness when squeezing the sides of the heel bone (positive squeeze test)
- Mild swelling or redness around the heel
- Limping or altered gait to avoid putting weight on the heel
- Start-up pain after sitting or resting for a prolonged period
Diagnosis
Diagnosis is typically made by a pediatrician, orthopedic specialist, or sports medicine physician. The evaluation includes:
- Medical history: Assessment of sports activity, onset of pain, and growth phase
- Physical examination: The squeeze test, applying pressure to both sides of the heel, is characteristic of Sever's disease
- X-ray: Primarily used to rule out other conditions such as fractures; findings in Sever's disease may be subtle or show minor changes at the growth plate
- Ultrasound or MRI: Used in ambiguous cases for further assessment
Treatment
Sever's disease is a self-limiting condition, meaning it resolves naturally once skeletal growth is complete. Treatment focuses on pain relief and load reduction:
Conservative Measures
- Rest or activity modification: Temporary reduction or suspension of painful activities
- Heel wedges and insoles: Orthopedic heel pads or wedges reduce tension on the Achilles tendon and cushion impact
- Physiotherapy: Stretching exercises for the calf muscles and Achilles tendon, along with foot strengthening exercises
- Ice therapy: Applying ice to the heel after activity to reduce pain and inflammation
- Pain relief medication: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be used short-term if needed
- Appropriate footwear: Sports shoes with good cushioning and supportive soles
Prognosis
The prognosis for Sever's disease is excellent. Symptoms typically resolve completely once heel growth is finished, usually between the ages of 13 and 15. No permanent damage to the bone or tendon is expected.
References
- Sever, J.W. (1912): Apophysitis of the os calcis. The New York Medical Journal, 95, 1025-1029.
- Rachel, J.N. et al. (2009): Is Sever disease the same as calcaneal apophysitis? A systematic review. Clinical Orthopaedics and Related Research, 467(7), 1825-1831.
- American Academy of Pediatrics (AAP): Sever's Disease (Calcaneal Apophysitis) - Clinical Overview. Available at: www.aap.org
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