Sever's Disease (Calcaneal Apophysitis) - A Misnamed Disorder

Sever's disease is a disorder that commonly occurs in active children between the ages of nine and thirteen years of age. Even though it is misnamed as a disease, it is actually a self-limiting disorder that occurs around the growth plate in the back of the heel.

The Achilles tendon attaches to the upper portion of the heel growth plate. On the bottom of the growth plate is an attachment of a ligament known as the plantar fascia. With increased activity there is a pulling or tugging that occurs on this growth plate, and a portion of the growth plate is being pulled away from its attachment to the heel. X-rays are often taken to verify the position and the location of this growth plate.

SEVERS

In mild cases, elevating the heel through heel lifts in the shoes and decreasing activity level may be enough to control the pain. In more severe cases, orthotic therapy to help control the motion of the heel as well as icing, elevation, and aspirin therapy may be required to alleviate the symptoms. In those children who do not respond to either of the above-mentioned therapy, it is sometimes necessary to place the child in a below-knee cast for a period of four to six weeks. It is important for both the child and parents to understand that once the growth plate has fused to the primary bone in the heel, the pain and swelling associated with this disorder should resolve.
Please realize that the disorder may last from a couple of weeks to as long as one to two years. The treatment plan as prescribed by your doctor MUST be adhered to closely. The activity level of the child must be controlled during the early stages of treatment. All running and jumping sports such as basketball, trampoline, volleyball, tennis, soccer, etc. must be eliminated as part of the initial treatment. Once the child has improved and the pain has subsided, then a rigid stretching program must be implemented.
The purpose of the stretching program is to decrease the pull of the Achilles tendon on the growth plate. In the event that the stretching and the heel lift do not provide relief of the symptoms, the next course of therapy is to limit the amount of motion of the heel through an insert in the shoes, called orthotics. The orthotic accomplishes two basic functions: (1) To elevate the heel and decrease the pull of the Achilles tendon. (2) To prevent the rocking motion of the heel while the child is active. Typically, I have found that the majority of children will respond favorably to this type of conservative care and be able to actively return to their respective sport with very little compromise. In those cases that do not respond well to the above conservative therapy, it is sometimes necessary to take the child out of the sport that is aggravating the condition, until such time that the growth plate fuses to the main bone of the heel.
Typical Treatments
Mild Cases
1. Discontinue all running, jumping, etc. activities.
2. Application of ice to the affected heel, 10 min. on 20 min. off, for 2-3 hours.
3. Aspirin as directed.
4. Heel lift.
Moderate Cases
1. Discontinue all strenuous activity.
2. Ice and elevation to the affected heel.
3. Anti-inflammatories.
4. Temporary orthotics with heel lift to be worn in all shoes.
Severe Cases
1. No weight bearing to the affected foot, crutch walking only,
2. Below knee casting for a period of 4-6 weeks.
3. Anti-inflammatories.
4. Treatment to follow based on symptoms after removing cast, i.e., mild/moderate.
Timely presentation for an examination following the first symptoms of heel pain in children, usually allows for a quick resolution to this condition. Treatments are also tailored to help prevent recurrence of the condition, and to allow for the child to maintain an active lifestyle.
Sever's Disease (Calcaneal Apophysitis) - A Misnamed Disorder
SEVERS