Sever's Disease (Calcaneal Aphophysitis) is not a disease, but a repetitious strain injury common in children between the ages of 8 and 14 years old. It is a common cause of heel pain, particularly in the very active child. Patients with Sever's disease complain of pain in the bottom surface region of the back of the heel. This is where the growth plate is located, and is not fully developed or calcified in a child's foot.
The heel bone sometimes grows faster than the leg muscles (including the calf muscles) and tendons (including the Achilles tendon) during the early puberty growth spurt. The different growth rate in these structures can cause lower leg muscles and tendons to become overstretched and tight, which makes the heel less flexible and puts excessive pressure on the heel growth plate. The Achilles tendon, the strongest tendon in the body, attaches to the heel growth plate, and repetitive stress on this structure, especially if it?s already tight, can damage the growth plate, leading to tenderness, swelling, and pain. Activities that involve running or jumping, such as soccer, gymnastics, track, and basketball, can place significant stress on a tight Achilles tendon and contribute to the onset of Sever?s disease. Ill-fitting shoes can also contribute to this health problem by failing to provide the right kind of support or by rubbing against the back of heel. The following factors may increase the likelihood of Sever?s disease in kids or young teens. Wearing footwear that is too narrow in the toe box. Leg length inequality. Obesity or carrying excess bodyweight. Excessive foot and ankle pronation.
Pain is usually felt at the back and side of the heel bone. Sometimes there may be pain at the bottom of the heel. The pain is usually relieved when the child is not active and becomes painful with sport. Squeezing the sides of the heel bone is often painful. Running and jumping make the symptoms worse. One or both heels can be affected. In more severe cases, the child may be limping.
This can include physical examination and x-ray evaluation. X-rays may show some increased density or sclerosis of the apophysis (island of bone on the back of the heel). This problem may be on one side or bilateral.
Non Surgical Treatment
Activity Modification: to decrease the pain, limiting sporting activities is essential. Cutting back on the duration, intensity, and frequency can significantly improve symptoms. Heel cord stretching is important if heel cord tightness is present. Heel cushions/cups or soft orthotics decreases the impact on the calcaneus by distributing and cushioning the weight bearing of the heel. Use of NSAIDS. Ibuprofen (Nuprin, Motrin) or naproxen (Aleve) can decrease pain and secondary swelling. Ice. Placing cold or ice packs onto the painful heel can alleviate pain. Short-leg cast. For recalcitrant symptoms a short-leg cast is occasionally used to force rest the heel.