Sever?s disease, also known as calcaneal apophysitis or Osgood-Schlatter syndrome of the foot. This traction apophysitis is secondary to repetitive microtraumata or overuse of the heel in young
athletes. The calcaneus is situated at the most plantar posterior aspect of the foot. The Achilles tendon inserts to the lower, posterior and slightly medial aspect of the calcaneus. The plantar
fascia originates from the medial tubercle on the plantar aspect of the calcaneus. Proximal to the epiphysis is the apophysis, where the Achilles tendon actually inserts. The calcaneal growth plate
and apophysis are situated in an area subject to high stress from the plantar and Achilles tendon.
Sever?s disease only occurs during a certain period of pre-adolescence, when the heel bone is going through a rapid growth spurt. In girls, this typically occurs around 8 to 10 years of age, and in
boys, between ages 10 and 13. Sever?s disease is more common in active, athletic children. The condition is difficult to prevent completely, but changing the type and amount of physical activity when
your child is experiencing pain will help.
The most common symptoms of Sever?s involves pain or tenderness in one or both heels. This pain usually occurs at the back of the heel, but can also extend to the sides and bottom of the heel. A
child with Sever?s may also have these common problems, Heel pain with limping, especially after running. Difficulty walking, Discomfort or stiffness in the feet upon awaking. Swelling and redness in
the heel, Symptoms are usually worse during or after activity and get better with rest.
Low-grade inflammation of the calcaneal apophysis cannot be seen on x-ray. Therefore, although x-rays are often done to rule out bony injuries in children with Sever's disease these x-rays are
usually normal. Advanced Sever's disease can be seen on x-ray but usually the problem is treated before it reaches this point. Other diagnostic tests, such as bone scans or MRI's, are not usually
required in typical cases of Sever's disease. These, or other tests, may be required to rule out other conditions, such as stress fractures of the calcaneus or other bony abnormalities that can mimic
Non Surgical Treatment
See a doctor, who can diagnose the injury and recommend appropriate treatment options. It will be beneficial to rest the affected heel, and to regularly ice the affected area for the first few days.
Anti-inflammatory pain medication can reduce pain and swelling, but first check with your doctor. As the pain diminishes a physical therapist can assist with a program of rehabilitation,
incorporating stretching and strengthening exercises focused on the calf, shin and hamstring muscles. For a period after the injury has healed the doctor may advise on changes to your training
routines that seek to lessen the strain on the heels. Orthotics are often recommended for your shoes in order to correct any biomechanical problems or lend extra support to the heels.
For children with Sever's disease, it is important to habitually perform exercises to stretch the hamstrings, calf muscles, and the tendons on the back of the leg. Stretching should be performed 2-3
times a day. Each stretch should be performed for 20 seconds, and both legs should be stretched, even if the pain is only in one heel. Heel cups or an inner shoe heel lifts are often recommended for
patient suffering from Sever's disease. Wearing running shoes with built in heel cups can also decrease the symptoms because they can help soften the impact on the heel when walking, running, or