Sever's disease (calcaneal apophysitis) is the term used to describe irritation (inflammation) of the calcaneal apophysis. This condition often occurs before or during the growth spurt in boys and girls, or shortly after they begin a new activity. Sever's disease is common is running and jumping sports.CausesSevers
disease is often associated with a rapid growth spurt. As the bones get longer, the muscles and tendons become tighter as they cannot keep up with the bone growth. The point at which the achilles tendon attaches to the heel becomes inflamed and the bone starts to crumble (a lot like osgood schlatters disease of the knee). Tight calf muscles may contribute as the range of motion at the ankle is reduced resulting in more strain on the achilles tendon. Sever's disease is the second most common injury of this type which is known as an apophysitis.Symptoms
Pain is reproduced through a gentle squeeze of the back of the heel. Children may present with a limp or ?Bouncy gait?. Pain is worse barefoot and often present in the mornings and post exercise. The pain is located at the back of the heel, with localized swelling of the area.Diagnosis
Most often, a healthcare professional can diagnose Sever?s disease by taking a careful history and administering a few simple tests during the physical exam. A practitioner may squeeze the heel on either side; when this move produces pain, it may be a sign of Sever?s disease. The practitioner may also ask the child to stand on their tiptoes, because pain that occurs when standing in this position can also be an indication of Sever?s disease.Non Surgical Treatment
Treatment includes modifying activities and resting to reduce pain and inflammation and take pressure off the growth center. Ice can also be very helpful in relieving symptoms, as well as anti-inflammatory medication. A physical therapy program should be initiated to stretch tight calf muscles and strengthen the ankle muscles to relieve tension on the growth center. Shoes with padded heel surfaces and good arch support can decrease pain. Cleats may need to be avoided for some time to help reduce symptoms. The doctor may also recommend gel heel cups or supportive shoe inserts.Recovery
If the child has a pronated foot, a flat or high arch, or another condition that increases the risk of Sever's disease, the doctor might recommend special shoe inserts, called orthotic devices, such as heel pads that cushion the heel as it strikes the ground, heel lifts that reduce strain on the Achilles tendon by raising the heel, arch supports that hold the heel in an ideal position, If a child is overweight or obese, the doctor will probably also recommend weight loss to decrease pressure on the heel. The risk of recurrence goes away on its own when foot growth is complete and the growth plate has fused to the rest of the heel bone, usually around age 15.