Also known as calcaneal apophysitis, Sever’s Disease is an irritation of the apophysis in the heel (calcaneus). This is a heel pain syndrome most commonly experienced by young athletes and children who have a recent episode of growth spurt, usually between the ages of 8-14 years old. This condition may affect one or both heels at the same time.

Frequently Asked Questions: 

1. What is an apophysis? 

An apophysis is the growth plate, which is a layer near the end of the bone where most of the bone growth happens.

 

2. What are the symptoms of Sever’s Disease?

Some of  the symptoms described includes: 

    • Pain around the heel during and following activities, particularly high impact sports such as basketball or footy
    • Swelling of the bottom and the back of the heel
    • Symptoms alleviate after a period of rest 
    • Tight calves or hamstrings

3. How does it happen? 

Contrary to nomenclature, Sever’s Disease is an overuse injury / phenomena. With kids who are very active or suddenly increase their sport training or other physical activities, they often overload their calcaneal growth plate by both traction from the Achilles tendon and compression forces from repetitive impact. This causes reversible abnormal changes in the apophysis, which leads to pain around the heel. 

 

4. How can it be diagnosed?

Clinical testing includes history taking, palpation and a thorough physical examination of the foot and lower limb. Imaging options such as x-ray and ultrasound will be able to rule out fractures of the heel bone or soft tissue damage. However, they will be unable to detect the irritation of the growth plate.

5. Can my kids play sports? 

Yes. Kids can still play sports when the sporting activities don’t cause any symptoms or pain. However, it is recommended to modify activities or find alternatives to reduce the load and impact on the symptomatic heel(s). 

 

6. Will it affect my child’s growth and does it have any long term effects? 

There is no evidence suggesting that Sever’s Disease has an impact on a child’s growth or development.  It doesn’t cause any long term issues once the symptoms have resolved. 

7. What can I do at home? 

    • Apply cold-heat compression 
    • Massage of the calves and hamstrings (You can also use a foam roller)
    • Gentle stretching
    • Strapping 
    • Apply topical anti-inflammatory (i.e Voltaren gel) to reduce swelling and inflammation around the area.

8. What does clinical treatment entail?

    • Activity modification
    • Footwear modification with heel lift 
    • Strapping or compression sock 
    • Guided exercise rehabilitation and more vigorous stretching once appropriate
    • Myofascial release of the foot and leg
    • Low level laser / photobiomodulation therapy

9. How long does it last?

The symptoms usually last for about 1-3 months with early detection and proper management. However, some individuals might experience these symptoms for years or can have recurrence if they do not follow the recommended protocol. 

 

10. Will it ever go away?

The growth plate finishes fusing at approximately the age of 15 years old, by which point they will not experience heel pain due to Sever’s Disease.

 

     

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