Sever's Disease in Adults
Sever's disease (calcaneal apophysitis) does not occur in adults because it is specifically a condition affecting the growth plate of the heel, which is only present in children and adolescents before skeletal maturity.
Understanding Sever's Disease
Sever's disease is defined as juvenile osteochondrosis of the calcaneus that occurs during periods of growth, specifically affecting children and adolescents between the ages of 8-15 years 1. It is characterized by:
- Pain in the posterior heel
- Mild swelling
- Positive "squeeze test" of the heel on physical examination
- Association with high-impact sports participation
Why Adults Cannot Develop Sever's Disease
The fundamental reason adults cannot develop true Sever's disease is anatomical:
Growth Plate Closure: Sever's disease specifically affects the calcaneal apophysis (growth plate), which closes and fuses with the main body of the calcaneus once skeletal maturity is reached.
Pathophysiology: The condition results from repetitive microtrauma to the open growth plate in the immature calcaneus during puberty 1. Once the growth plate closes (typically by age 15-16), this specific pathology cannot occur.
Differential Diagnosis for Adult Heel Pain
When adults present with heel pain similar to what might be described as "Sever's-like," the following conditions should be considered:
- Plantar fasciitis
- Achilles tendinopathy
- Retrocalcaneal bursitis
- Calcaneal stress fracture
- Tarsal tunnel syndrome
- Posterior ankle impingement
Clinical Evidence
The medical literature consistently describes Sever's disease as a pediatric condition:
- It is "the primary cause of heel pain in pediatric patients between the ages of 8 and 15 years" 1
- It "mainly occurs during puberty with an open growth plate in the immature calcaneus" 1
- It is a "prevalent pediatric condition" 2
Management Implications
The distinction between pediatric Sever's disease and adult heel pain is important because:
- Treatment approaches differ significantly
- Prognosis varies (Sever's disease in children is self-limiting with no long-term effects 1)
- Diagnostic workup should be directed toward adult pathologies when similar symptoms present in adults
Key Takeaways
- Sever's disease is exclusively a pediatric condition affecting children and adolescents with open growth plates
- Adults with posterior heel pain require evaluation for other conditions
- The absence of a calcaneal growth plate in adults makes true Sever's disease anatomically impossible
If an adult presents with heel pain similar to Sever's disease symptoms, a thorough evaluation for other causes of heel pain is warranted, as the underlying pathophysiology must be different from true calcaneal apophysitis.