Sever's Disease (Calcaneal Aphophysitis) is not a disease, but a repetitious strain injury common in children between the ages of 8 and 14 years old. It is a common cause of heel pain, particularly
in the very active child. Patients with Sever's disease complain of pain in the bottom surface region of the back of the heel. This is where the growth plate is located, and is not fully developed or
calcified in a child's foot.
A big tendon called the Achilles tendon joins the calf muscle at the back of the leg to the heel. Sever?s disease is thought to occur because of a mismatch in growth of the calf bones to the calf
muscle and Achilles tendon. If the bones grow faster than the muscles, the Achilles tendon that attaches the muscle to the heel gets tight. At the same time, until the cartilage of the calcaneum is
ossified (turned into bone), it is a potential weak spot. The tight calf muscle and Achilles tendon cause a traction injury on this weak spot, resulting in inflammation and pain. Sever?s disease most
commonly affects boys aged ten to 12 years and girls aged nine to 11 years, when growth spurts are beginning. Sever?s disease heals itself with time, so it is known as ?self-limiting?. There is no
evidence to suggest that Sever?s disease causes any long-term problems or complications.
Symptoms include Heel Pain. Pain at the back of the heels when walking or running. Possibly a lump at the back of the heel, although this might be minimal. Pain and tenderness at the back of the
heels, especially if you press on it, or give it a squeeze from the sides. Tight calf muscles resulting in reduced ankle range of motion.
A physical exam of the heel will show tenderness over the back of the heel but not in the Achilles tendon or plantar fascia. There may be tightness in the calf muscle, which contributes to tension on
the heel. The tendons in the heel get stretched more in patients with flat feet. There is greater impact force on the heels of athletes with a high-arched, rigid foot. The doctor may order an x-ray
because x-rays can confirm how mature the growth center is and if there are other sources of heel pain, such as a stress fracture or bone cyst. However, x-rays are not necessary to diagnose Sever?s
disease, and it is not possible to make the diagnosis based on the x-ray alone.
Non Surgical Treatment
A doctor, sports therapist or physiotherapist can apply a plaster cast or boot if the child is in severe pain. This may be worn for a few days or even weeks and should give relief of pain for a
while. Carry out a full biomechanical assessment. This may help to determine if any foot biomechanics issues are contributing to the condition. Orthotics or insoles can be prescribed to help correct
over pronation or other biomechanics issues. Prescribe anti-inflammatory medication such as ibuprofen to reduce pain and inflammation. This will not be prescribed if asthma the child has asthma. In
persistent cases X-rays may be taken but this is not usual. A doctor, sports therapist or physiotherapist will NOT give a steroid injection or operate as these are not suitable treatment options. The
condition will usually settle within 6 months, although it can persist for longer.
It may take several weeks or months for the pain to completely stop. When the pain is completely gone, your child may slowly return to his or her previous level of activity.