From the Guidelines
Sever's syndrome, also known as calcaneal apophysitis, is a common cause of heel pain in teenage athletes, particularly those aged 8-14 years, and palliative treatment is almost always successful. This condition occurs when the growth plate in the heel becomes inflamed due to repetitive stress and tension from the Achilles tendon during periods of rapid growth. According to the American College of Foot and Ankle Surgeons, as reported in the American Family Physician journal in 2002 1, calcaneal apophysitis is probably the most common cause of heel pain in adolescents.
Key Characteristics of Sever's Syndrome
- It is a self-limiting condition that typically resolves when growth is complete, usually within 2-8 weeks with proper management.
- The condition is more prevalent in active teenagers who participate in running and jumping sports like soccer, basketball, and gymnastics.
- Treatment typically involves rest from painful activities, ice application, over-the-counter pain medications, heel cushions or cups in shoes, and gentle calf stretching exercises.
Management and Treatment
- Rest from painful activities is crucial to prevent further irritation of the growth plate.
- Ice application for 15-20 minutes several times daily can help reduce pain and inflammation.
- Over-the-counter pain medications like ibuprofen or acetaminophen can be used to manage pain, with dosages of 5-10mg/kg every 6-8 hours for ibuprofen and 10-15mg/kg every 4-6 hours for acetaminophen.
- Heel cushions or cups in shoes can help reduce stress on the heel.
- Gentle calf stretching exercises held for 30 seconds and repeated 3 times, 2-3 times daily, can help improve flexibility and reduce tension on the Achilles tendon.
- Physical therapy focusing on stretching and strengthening may be beneficial in more persistent cases.
- Most teenagers can continue modified sports participation as pain allows, emphasizing the importance of balancing treatment with the need to maintain physical activity levels.
From the Research
Definition and Causes of SEVERS Syndrome
- SEVERS syndrome, also known as Sever's disease or calcaneal apophysitis, is a common cause of heel pain in adolescent athletes, particularly those involved in running or jumping activities 2, 3, 4.
- The condition occurs during the pubertal growth spurt, with a mean age of presentation of 10 years (range 7-15) 2.
- SEVERS syndrome is brought about by repetitive submaximal loading and microtrauma, and is considered an overuse syndrome 2.
Risk Factors and Symptoms
- Primary risk factors for SEVERS syndrome in pediatric athletes include obesity and high levels of physical activity 3.
- The condition primarily results from high-impact sports such as soccer, track, cross-country, gymnastics, tennis, and ballet 3.
- Symptoms include posterior heel pain that is worse with activity and relieved by rest in most cases, as well as localized swelling and bony expansion in some cases 2, 4.
Diagnosis and Treatment
- Clinical diagnosis can be confirmed by performing a "squeeze test" of the heel on physical examination 3.
- Diagnostic imaging findings include increased sclerosis and fragmentation of the calcaneal apophysis on plain radiograph x-rays 3.
- Treatment methods include ice, activity restriction, stretching, nonsteroidal anti-inflammatory drugs, immobilization, and heel cups 3, 4, 5.
- Conservative treatment, including insoles, therapeutic exercises, Kinesio taping, and foot orthoses, has been shown to be effective in alleviating symptoms associated with SEVERS syndrome 5, 6.