Severs disease can present many difficulties to primary care clinicians, athletic trainers and patients. It’s often misdiagnosed as plantar fasciitis and overtreated or left alone altogether.
Sever disease, also known as calcaneal apophysitis, typically develops during periods of rapid bone, muscle, and tendon growth. Physical activity often pulls on an unossified heel growth plate causing pain and inflammation.
Causes
Sever’s disease (or calcaneal apophysitis) affects the area of the heel bone where new bone growth occurs, making this area of soft and weaker tissue susceptible to injury. Most commonly found among active children between 8-14, especially those involved in sports that require running or jumping as well as prolonged walking for prolonged periods. It most often strikes those engaging in intense physical activities like sports that involve jumping, running or long periods of walking – an activity most common with active children aged 8-14 who engage in intense physical activities such as sports that involve running or jumping or long periods of walking for prolonged periods.
Boys are more prone to Sever’s disease than girls and symptoms typically last until the growth plate closes at age 15 (though pain may return in older children when engaging in physical activities again). It may resurface again later.
A podiatrist can diagnose Sever’s disease in children by conducting an examination and taking a detailed history. They may suggest stopping activities that cause discomfort, using ice packs, wearing supportive footwear, and performing calf stretches as treatments.
Sever’s disease should be distinguished from heel spurs, which are bony bumps on the underside of the heel bone that cause pain when flattened. A podiatrist will also test flexability of Achilles tendon by gently squeezing back of heel – if tenderness or pain arises at apophysis then Sever’s disease likely exists.
Symptoms
Children and adolescents participating in high-impact activities, particularly those that involve repeated running or jumping, may develop Sever’s disease – also known as calcaneal apophysitis – which occurs when repetitive stress inflames the growth plate of their heel bone (heel apophysis).
Sever’s disease causes pain that worsens with physical activity and improves with rest, often felt at the back or sides of the heel. It may be brought on by wearing shoes without adequate arch support, participating in high-impact sports like basketball or track and field, or by wearing inappropriate footwear.
To assess Sever’s disease, our podiatrist will conduct a simple test by gently squeezing the area around the heel. If a child experiences pain during this test, this indicates an inflamed growth plate.
Sever’s disease can be easily treated. Our providers will advise your child to decrease activity levels, while physical therapy helps strengthen and promote healing in affected areas. In addition, we can advise on appropriate footwear choices – typically this condition resolves within months without long-term issues arising; recurrence usually only occurs if levels of activity increase significantly – yet wearing supportive footwear that protects both feet and heels is an invaluable preventative measure.
Diagnosis
A podiatrist can establish Sever disease through an easy test known as the “squeeze” test, which involves lightly squeezing both sides of your child’s heel area where their growth plate resides and applying gentle pressure with both hands – if your child experiences pain during this procedure it indicates inflammation of their calcaneal growth plate and should be considered positive result.
Resting and limiting activities that aggravate their condition will often help alleviate symptoms. Ice application is helpful to decrease pain and swelling. Anti-inflammatory medications like ibuprofen and naproxen can also relieve any associated discomfort, while heel pads or lifts may be recommended to ease stress on the calcaneus bone. In more serious cases, a short leg cast may provide needed immobilization while providing rest for your child’s foot; stretching and strengthening exercises may then be reinstated once they’re pain free.
Prompt diagnosis by an experienced foot and ankle specialist is of critical importance when managing Sever disease in children, as this will enable proper treatments to begin earlier and allow your child to return to regular activity more quickly than if left untreated. Understanding its underlying pathophysiology is also vital for all healthcare providers including primary care clinicians, physical therapists, coaches, and athletic trainers as it will improve overall patient outcomes.
Treatment
Sever’s disease can be diagnosed by heel pain that worsens with physical activity, most frequently during puberty (usually between 8-15). Children involved in sports involving running, jumping or high impact forces often develop it first – usually male athletes more so. Boys typically develop it more than girls. It typically manifests itself during rapid development between 8 and 15 years.
Sever’s disease causes pain and tenderness through inflammation at the end of a bone known as a calcaneal (heel) apophysis. Made of soft cartilage, this structure can easily become injured through stress or injury, particularly during times of rapid growth spurts such as puberty. Therefore it’s wise to limit physical activity during growth spurts as overuse of bones and tendons can result in Sever’s disease.
Resting from activities that exacerbate pain, applying ice to the heel for 15 minutes every hour, and performing calf stretches are effective treatments. Over-the-counter nonsteroidal anti-inflammatory medication may also help relieve discomfort and swelling; footwear changes to reduce stress on the heel such as wearing lower heeled shoes or taking steps such as taking off athletic studs can be helpful; for severe symptoms it may be necessary to consult a physician regarding an ankle brace prescription. Severs disease is impossible in adults.