Severs disease (calcaneal apophysitis) is a self-limiting condition seen in physically active children. Although there is controversy about the radiographic appearance, some reports propose the
importance of fragmentation of the secondary nucleus in the diagnosis of Severs disease. We studied secondary nucleus of the calcaneus with ultrasonography. Twenty-one symptomatic heels of 14
children were examined. All these heels showed fragmentation of the secondary nucleus on both conventional radiograph and sonography. Ultrasonographic examination also showed 2 retrocalcaneal
bursitis. Our initial data showed that sonography may be valuable in the diagnosis of Severs disease.
Physically active children run the risk of developing Sever?s disease because they put the most strain on their growing bones. Sever?s usually occurs during the adolescent growth spurt, when young
people grow most rapidly. (This growth spurt can begin any time between the ages of 8 and 13 for girls and 10 and 15 for boys.) By age 15 the back of the heel usually finished growing. As teens grow,
the growth plates harden and the growing bones fuse together into mature bone. Young people engaged in physical activities and sports that involve jumping and running on hard surfaces-such as track,
basketball, soccer, and gymnastics-are ata higher risk for developing Sever?s disease. Poor-fitting shoes can contribute by not providing enough support or padding for the feet or by rubbing against
the back of the heel.
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.
X-rays are normal in Sever's disease, but your doctor will probably get X-rays to rule out other problems. Treatment consists of non-steroidal anti-inflammatory medications and use of a heel lift to
relieve tension on the calcaneal apophysis. In more severe cases, phycical therapy consisting of modalities to relieve the pain, and stretching exercises may be helpful. In extreme cases, castings
have been used.
Non Surgical Treatment
Depending on the Podiatrist's diagnosis and the severity of the pain, there are several treatment options available. Rest/ reduced activity: your child should reduce or stop any activity that causes
pain, such as sports and running. This can be a difficult option, as children are normally quite willful in pursuit of their favorite pastimes! Over the counter anti-inflammatory drugs, such as
ibuprofen (found in Nurofen), to help reduce pain and inflammation. Try to make sure your child does the recommended stretching exercises before sport/play. This will should help reduce the stress on
the fascia tendon and relieve heel pain. The use of Orthotic insoles. Footactive Kids orthotics are made for children. They will help properly support the foot, help prevent over-pronation or
improper gait restoring your child's foot the the correct biomechanical position. If you are in any doubt or your child's foot pain persists then please arrange an appointment with a Podiatrist or
Physiotherapist. Please click here for more information on the use of orthotics for children.
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel.
Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and
inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a
cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence
of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle