From the Guidelines
Sever's disease, also known as calcaneal apophysitis, is a common cause of heel pain in growing children, particularly those who are physically active. It occurs when the growth plate in the heel bone (calcaneus) becomes inflamed due to repetitive stress and tension from the Achilles tendon. This condition typically affects children between the ages of 8 and 14, especially during growth spurts when bones grow faster than muscles and tendons, creating additional tension at attachment points.
Key Characteristics
- The condition is self-limiting and typically resolves when growth is complete, but symptoms usually improve within 2-8 weeks of treatment 1.
- Calcaneal apophysitis is probably the most common cause of heel pain in adolescents, with palliative treatment being almost always successful 1.
Treatment Approach
- Rest from painful activities is essential, though complete activity restriction is rarely necessary.
- Ice application for 15-20 minutes several times daily helps reduce inflammation.
- Over-the-counter pain medications like ibuprofen or acetaminophen can manage pain.
- Heel cups, cushions, or orthotics provide support and reduce tension on the heel.
- Stretching exercises for the calf muscles and Achilles tendon should be performed 2-3 times daily, holding each stretch for 30 seconds.
- Physical therapy may be beneficial in more persistent cases. Treatment for Sever's disease focuses on reducing pain and inflammation while allowing the heel to heal, and if pain persists despite these measures or becomes severe, medical evaluation is recommended to rule out other conditions.
From the Research
Definition and Description of Sever's Disease
- Sever's disease is a prevalent pediatric condition that causes heel pain in children worldwide 2.
- It is often described as an overuse injury that can present with either unilateral or bilateral heel pain 2.
- The condition is characterized by inflammation of the calcaneal apophysis due to the repeated traction of the Achilles tendon on its insertion site 3.
Causes and Mechanism of Injury
- The exact mechanism of injury is unknown, but it is often thought to involve repetitive stress and pressure on the calcaneal growth plate 2.
- The condition is commonly associated with growth spurts in children, particularly those who are active in sports or other physical activities 3.
Diagnosis and Therapeutic Options
- Diagnosing Sever's disease mainly relies on a thorough clinical investigation and physical examination, with a positive squeeze test usually sufficient to establish diagnosis 2.
- Radiographic imaging can help exclude other differential diagnoses 2.
- Therapeutic options for Sever's disease are mostly conservative, and these include rest, physical therapy, kinesiotherapy, and orthoses 2.