Sever's Disease (Calcaneal Apophysitis)

The true name of this complaint is calcaneal apophysitis which just means an inflamation of the growth centre of the bone in your heel as a result of pulling by the Achilles tendon - it is important to realise that it is not a disease but rather a condition that develops in the growing skeleton with activity.  

It is the most common cause of heel pain in young athletes, and is the second most common condition of its kind in the younger athelete after Osgood-Schlatter's disease.  It is often seen at a time of rapid growth during which the muscles and soft tissues become tighter as the bones get longer.  It occurs more in boys than girls and is seen most commonly between the ages of 8 and 14 years though it tends to be more prevalent in the younger of this group.

The pain of Severs usually occurs because of inflammation and micro-trauma to the growth plate of the heel bone. This can be caused by a sudden increase in activity, running on very hard surfaces, a growth spurt, tight muscles or feet that roll in.  

The patient complains of activity related pain that usually settles with rest. On Examination the heel bone – or calcaneum – is tender on one or both sides.  The gastrocnemius and soleus muscles (calf muscles) may be tight and bending of the ankle might be limited because of that. Foot pronation (rolling in) often exacerbates the problem.  There is rarely anything to see and with no redness or swelling and a pain that comes and goes mum and dad often wait before seeking advice on this condition. The pain may come on partway through a game and get worse or come at the end of the game. Initially pain will be related only to activity but as it gets worse the soreness will still be there the next morning and the child might limp on first getting up.

The pain often begins at a time of increased activity - so in the gymnast this often occurs when they add in cross-country training for school or for the non-gymnast when they add training for winter season and they are still competing in the summer comp- we therefore often have a rush of Sever's patients around March/April!

Management consists of explanation of what's happening and advice on activity modification to get it to settle. Icing after activity and heating during breaks in activity also often help. Local treatment with electrotherapy may be indicated in the acute stage or to help settle pain for a specific activity/competition. Stretches will be advised and the child may require orthotics to control foot position.  A heel raise or heel cups may also help. Strapping may be of some benefit. The mainstay of treatment however is the icing and activity modification and reassurance that the condition is self-limiting - this may take up to 2 years.