Sever's disease also known as calcaneal apophysitis is one of the most common causes of heel pain in developing athletes and growing children between the ages of 8 and 15. It is usually related with a growth spurt. It is caused due to chronic overuse and recurrent microtrauma to the growth plates of the calcaneus in the heel. As the growth of the child increases the bones increase in length and the muscles and tendons become tauter.
About Sever's Disease or Calcaneal Apophysitis
The location where Achilles tendon joins the heel gets inflamed and tender with bone beginning to disintegrate. This is similar to Osgood Schlatter disease which affects the knee whereas Sever's Disease or Calcaneal Apophysitis affects the heel and ankle.
After Osgood Schlatter disease, Sever's Disease or Calcaneal Apophysitis is the most frequent disease of this nature seen in children and adolescents. This condition commonly resolves within 6 months, however, in some cases it may continue longer. It is named after J.W. Sever, who characterized it in 1912.
Sever's Disease or Calcaneal Apophysitis usually resolves on its own after adequate rest is given to the heel. It affects the boys more than girls.
Signs of Sever's Disease or Calcaneal Apophysitis
- Experience of pain in heels, especially when walking or running.
- A lump may be present at the heel, although it is uncommon.
- Pain upon pressure at the back of heels.
- Increasing pain after walking or exercise.
- Reduced range of motion in the ankle due to tight gastrosoleus muscles.
Causes of Sever's Disease or Calcaneal Apophysitis
Sever's Disease or Calcaneal Apophysitis is caused due to overuse of the tendons and bone in the heel. This is usually due to repetitive heel movement as seen while playing sports. In growing children, excessive weight bearing on the heel causes excessive traction as the bones and tendons are still developing and are still soft. Children who over-pronate are more vulnerable to this condition. It affects both the heels in 50% of the patients.
Treatment of Sever's Disease or Calcaneal Apophysitis
- Ice therapy application to heel. Ice should never be applied directly to skin but should be wrapped in towel to prevent ice burns.
- Rest from aggravating activities.
- A heel raise can be inserted into the shoes. This helps in taking the strain off the Achilles tendon and reducing the tug on the bone.
- The calf muscles should be stretched regularly.
- Casting can be used for pain relief.
- A full assessment should be done by a specialist.
- Orthotics or insoles may be used.
- Anti-inflammatory medications such as ibuprofen help in pain relief.
- The heel should be kept in an elevated position.
- Steroid injections or surgery is not a suitable treatment.
Prevention of Sever's Disease or Calcaneal Apophysitis
- Excessive running especially on hard surfaces should be avoided.
- Stretching exercises should be done regularly to maintain flexibility.
- Well-fitting, good quality shoes which have stable support and a shock-absorbent sole should be used.