Sever's Disease

Sever's disease (calcaneal apophysitis) is a traction apophysitis of the calcaneal apophysis and the most common cause of heel pain in children and young adolescents.

It typically presents between 8 and 14 years, often in both heels, in children doing running, jumping and court sports. It is a clinical diagnosis and usually settles when the apophysis fuses, although symptoms can fluctuate for 1 to 2 years.

The calcaneal apophysis is a secondary ossification centre at the back of the calcaneus. It appears at around 7 to 8 years and fuses with the body by around 14 to 16 years. The Achilles tendon inserts into it, and while it is partly ossified the cartilage-bone junction is the mechanical weak link.

The apophysis is loaded in 2 ways:

• •Traction: in the growth spurt, bone lengthens faster than the gastrocnemius-soleus complex, so relative calf tightness increases Achilles pull
• •Compression: impact at heel strike, especially on hard surfaces

Associated factors include limited ankle dorsiflexion, foot alignment, higher body mass index, high training volumes, rapid load increases and hard playing surfaces. Unlike Osgood-Schlatter disease, Sever's does not usually leave a bony prominence.