Sever's disease (calcaneal apophysitis) is a common cause of heel pain, particularly in physically active young people who are about to begin puberty. The cause is uncertain, but it is thought that
the long calf bones of the leg grow faster than the surrounding muscle and soft tissue, causing the Achilles tendon to pull uncomfortably tight.
During the growth spurt of early puberty, the heel bone (also called the calcaneus) sometimes grows faster than the leg muscles and tendons. This can cause the muscles and tendons to become very
tight and overstretched, making the heel less flexible and putting pressure on the growth plate. The Achilles tendon (also called the heel cord) is the strongest tendon that attaches to the growth
plate in the heel. Over time, repeated stress (force or pressure) on the already tight Achilles tendon damages the growth plate, causing the swelling, tenderness, and pain of Sever's disease. Such
stress commonly results from physical activities and sports that involve running and jumping, especially those that take place on hard surfaces, such as track, basketball, soccer, and
The typical patient is a child between 10 and 13 years of age, complaining of pain in one or both heels with running and walking. The pain is localized to the point of the heel where the
tendo-Achilles inserts into the calcaneus, and is tender to deep pressure at that site. Walking on his toes relieves the pain.
Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a "squeeze test" and some other tests to confirm the diagnosis. Some children suffer
Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors
thought to predispose a child to Sever?s disease include decrease ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing activities
Non Surgical Treatment
In mild cases, elevating the heel through heel lifts in the shoes and decreasing activity level may be enough to control the pain. In more severe cases, orthotic therapy to help control the motion of
the heel, as well as icing, elevating, and aspirin therapy may be required to alleviate the symptoms. In those children who do not respond to either therapy mentioned above, it is sometimes necessary
to place the child in a below-knee cast for a period of 4-6 weeks. It is important for both the child and parents to understand that the pain and swelling associated with this disorder should resolve
once the growth plate has fused to the primary bone in the heel.
Exercises that help to stretch the calf muscles and hamstrings are effective at treating Sever's disease. An exercise known as foot curling, in which the foot is pointed away from the body, then
curled toward the body in order to help stretch the muscles, has also proven to be very effective at treating Sever's disease. The curling exercise should be done in sets of 10 or 20 repetitions, and
repeated several times throughout the day.