Sever?s disease is a common cause of heel pain, particularly in the young and physically active. Just before puberty the calf bones typically grow faster than the surrounding soft tissue, which means the Achilles tendon is pulled uncomfortably tight. This can lead to an injured heel. Treatment includes relative rest, modifying activities and teaching the young person how to manage the condition when a flare-up happens. Sever?s disease is self-limiting and rarely causes long-term problems.
The calcaneal apophysis develops as an independent center of ossification (possibly multiple). It appears in boys aged 9-10 years and fuses by age 17 years, it appears in girls at slightly younger ages. During the rapid growth surrounding puberty, the apophyseal line appears to be weakened further because of increased fragile calcified cartilage. Microfractures are believed to occur because of shear stress leading to the normal progression of fracture healing. This theory explains the clinical picture and the radiographic appearance of resorption, fragmentation, and increased sclerosis leading to eventual union. The radiographs showing fragmentation of the apophysis are not diagnostic, because multiple centers of ossification may exist in the normal apophysis, as noted. However, the degree of involvement in children displaying the clinical symptoms of Sever disease appears to be more pronounced. In a study of 56 male students from a soccer academy, of whom 28 had Sever disease and 28 were healthy control subjects, findings suggested that higher heel plantar pressures under dynamic and static conditions were associated with Sever disease, though it was not established whether the elevated pressures predisposed to or resulted from the disease. Gastrocnemius ankle equinus also appeared to be a predisposing factor.
Symptoms of calcaneal apophysitis may include Pain in the back or bottom of the heel, Limping, Walking on toes, Difficulty running, jumping, or participating in usual activities or sports, Pain when the sides of the heel are squeezed.
Physical examination varies depending on the severity and length of involvement. Bilateral involvement is present in approximately 60% of cases. Most patients experience pain with deep palpation at the Achilles insertion and pain when performing active toe raises. Forced dorsiflexion of the ankle also proves uncomfortable and is relieved with passive equinus positioning. Swelling may be present but usually is mild. In long-standing cases, the child may have calcaneal enlargement.
Non Surgical Treatment
Your podiatrist can help manage this condition by implementing a treatment program. This may incorporate one or all of the following. RI (Rest and Ice). Activity modification so child becomes pain free. Daily stretching routine. Heel raise within shoes to decrease pull on heel. Biomechanical abnormalities corrected (Orthotics). Strengthening of associated muscles. Footwear modification.