Sever's disease is a common cause of heel pain in active children. Sever's disease, also called calcaneal apophysitis, occurs when the growth plate of the heel is injured by excessive forces during
The cause of the pain in Severs disease is thought to be the tractional forces applied to the growth plate of the heel bone by the Achilles tendon at the rear of the heel bone and the plantar fascia
just beneath the heel bone. This pulling force by the Achilles tendon on the growth plate is often aggravated by tight calf muscles and excessively pronated feet (i.e. feet that ?roll in? too
The most prominent symptom of Sever's disease is heel pain which is usually aggravated by physical activity such as walking, running or jumping. The pain is localized to the posterior and plantar
side of the heel over the calcaneal apophysis. Sometimes, the pain may be so severe that it may cause limping and interfere with physical performance in sports. External appearance of the heel is
almost always normal, and signs of local disease such as edema, erythema (redness) is absent. The main diagnostic tool is pain on medial- lateral compression of the calcaneus in the area of growth
plate, so called squeeze test. Foot radiographs are usually normal. Therefore the diagnosis of Sever's disease is primarily clinical.
A doctor or other health professional such as a physiotherapist can diagnose Sever?s disease by asking the young person to describe their symptoms and by conducting a physical examination. In some
instances, an x-ray may be necessary to rule out other causes of heel pain, such as heel fractures. Sever?s disease does not show on an x-ray because the damage is in the cartilage.
Non Surgical Treatment
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel.
Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and
inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a
cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence
of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle
In some cases, children will simply outgrow Sever's Disease when they reach a certain age, but this does not mean that symptoms should be ignored. If children express that they are in pain, this
should always be taken seriously by their parents or guardians. Heel pain may be a sign of Sever's Disease and this condition should not be left untreated, due to the damage it can cause to the
growing heel bones. Scheduling a doctor's appointment is always the first step to take in gaining a diagnosis of symptoms and speedy help for the child.