Calcaneal apophysitis (Sever?s disease) is the most common cause of heel pain in young athletes. Calcaneal apophysitis is a painful inflammation of the heel?s calcaneal apophysis growth plate,
believed to be caused by repetitive microtrauma from the pull of the Achilles tendon on the apophysis. Patients with calcaneal apophysitis may have activity-related pain in the posterior aspect of
the heel. 60 percent of patients report bilateral pain. This condition is usually treated conservatively with stretching and arch supports. The young athlete should be able to return to normal
activities as the pain decreases. Calcaneal apophysitis (Sever?s Disease) may last for months. Increasing pain, despite measures listed below, warrants a return visit to the physician.
Sever condition is caused by sprain injury where the Achilles tendon attaches to the calcaneus bone at the back of the heel. Sever condition occurs in adolescent or older children, particularly
active boys. It can be very painful. It is one of those conditions commonly referred to as "growing pains." Patients are evaluated for signs of conditions that can mimic Sever condition, such as
ankylosing spondylitis and other forms of arthritis. Usually Sever condition is self-limited; that is, it disappears as the child ages.
The most obvious sign of Sever's disease is pain or tenderness in one or both heels, usually at the back. The pain also might extend to the sides and bottom of the heel, ending near the arch of the
foot. A child also may have these related problems, swelling and redness in the heel, difficulty walking, discomfort or stiffness in the feet upon awaking, discomfort when the heel is squeezed on
both sides, an unusual walk, such as walking with a limp or on tiptoes to avoid putting pressure on the heel. Symptoms are usually worse during or after activity and get better with rest.
Sever?s disease is diagnosed based on a doctor?s physical examination of the lower leg, ankle, and foot. If the diagnosis is in question, the doctor may order x-rays or an MRI to determine if there
are other injuries that may be causing the heel pain.
Non Surgical Treatment
Most patients with Sever?s Disease can be treated with a self-guided home exercise program. Your healthcare provider will discuss with you if a prescription for formal physical therapy is indicated
instead of a self-directed home or school exercise program. Rest (protection of the heel). Ice (Ice 20 minutes at a time, 2-3 times a day). Gel heel pads / inserts. Anti-inflammatory medication. Well
cushioned pair of shoes. Brace (Cheetah) *Generally given for those who cannot wear shoes during their sport. Low impact aerobic training such as walking, riding a bike, elliptical or swimming. Home
exercise program focusing on increasing the flexibility of the heel cord and calf muscle.
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