Sever’s Disease – Calcaneal Apophysitis

What is Sever’s Disease?

Sever’s Disease is also known as Calcaneal Apophysitis.

Sever’s disease occurs mainly in active children aged 8 to 15 years old and results in heel pain. It is often associated with a rapid growth spurt. As the bones get longer, the muscles and tendons become tighter.

What are symptoms of Sever’s Disease?

Symptoms of Sever’s Disease 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

What are the causes of Sever’s Disease?

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.

Some common causes of Sever’s Disease may include:

  • Overuse: Overuse and stress on the heel bone through participation in sports is a major cause of calcaneal apophysitis. The heel’s growth plate is sensitive to repeated running and pounding on hard surfaces, resulting in muscle strain and inflamed tissue. For this reason, children and adolescents involved in soccer, track, or basketball are especially vulnerable
  • Obesity
  • Flat Foot

How is Sever’s Disease diagnosed?

  • Physical Examination
  • X-ray of heel may show increased sclerosis and fragmentation of the calcaneal apophysis but these features are nonspecific and it may be normal. The value of X-ray is to exclude fracture or a rare tumour. The diagnosis is clinical, not radiological.
  • MRI scan may be useful to exclude osteomyelitis or fusion of the small bones of the hindfoot. It is not always required

What are the treatments for Sever’s Disease?

  • Resting
  • Medication
  • Physiotherapy

How to prevent Sever’s Disease?

  • Avoiding obesity
  • Choosing well-constructed, supportive shoes that are appropriate for the child’s activity
  • Avoiding or limiting wearing of cleated athletic shoes
  • Avoiding activity beyond a child’s ability.

NOTE: Sever’s Disease is not a serious problem. IF your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon, Dr Kevin Yip at (65) 64762106.