Sever's disease is a term used to describe inflammation of the calcaneal apophysis which occurs in children and adolescents. Sever first described the condition in 1912. Further studies have
suggested that the condition is due to repeated 'microtrauma' at the site of the attachment of the Achilles tendon to the apophysis of the heel, often as result of sporting activities. The disorder
can be classified among the general osteochondrosis syndromes such as Osgood-Schlatter disease.
The heel bone grows faster than the ligaments in the leg. As a result, muscles and tendons can become very tight and overstretched in children who are going through growth spurts. The heel is
especially susceptible to injury since the foot is one of the first parts of the body to grow to full size and the heel area is not very flexible. Sever?s disease occurs as a result of repetitive
stress on the Achilles tendon. Over time, this constant pressure on the already tight heel cord can damage the growth plate, causing pain and inflammation. Such stress and pressure can result from
sports that involve running and jumping on hard surfaces (track, basketball and gymnastics). Standing too long, which puts constant pressure on the heel. Poor-fitting shoes that don?t provide enough
support or padding for the feet. Overuse or exercising too much can also cause Sever?s disease.
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 (heel bone), and is tender to deep pressure at that site. Walking on his toes relieves the pain.
Your podiatrist will take a comprehensive medical history and perform a physical examination including a gait analysis. The assessment will include foot posture assessment, joint flexibility (or
range of motion), biomechanical assessment of the foot, ankle and leg, foot and leg muscle strength testing, footwear assessment, school shoes and athletic footwear, gait analysis, to look for
abnormalities in the way the feet move during gait, Pain provocation tests eg calcaneal squeeze test. X-rays are not usually required to diagnose Sever?s disease.
Non Surgical Treatment
The following are different treatment options Rest and modify activity. Limit running and high-impact activity to rest the heel and lessen the pain. Choose one running or jumping sport to play at a
time. Substitute low-impact cross-training activities to maintain cardiovascular fitness. This can include biking, swimming, using a stair-climber or elliptical machine, rowing, or inline skating.
Reduce inflammation. Ice for at least 20 minutes after activity or when pain increases. Nonsteroidal anti-inflammatory drugs (NSAIDs) may also help. Stretch the calf. Increase calf flexibility by
doing calf stretches for 30 to 45 seconds several times per day. Protect the heel. The shoe may need to be modified to provide the proper heel lift or arch support. Select a shoe with good arch
support and heel lift if possible. Try heel lifts or heel cups in sports shoes, especially cleats. Try arch support in cleats if flat feet contribute to the problem. Take it one step at a time.
Gradually resume running and impact activities as symptoms allow. Sever?s disease usually goes away when the growth plate (apophysis) matures, which should be by age 12 to 13 years in females and 13
to 14 years in males.
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.