Sever’s disease (calcaneal apophysitis)

What is Sever’s disease?

Sever’s disease is the leading cause of heel pain in young athletes. While the condition sounds serious, it’s actually temporary and doesn’t cause long-term problems. Still, heel pain can affect an athlete’s ability to run, jump and be active.

This painful heel condition is both a growth-related disorder and an overuse injury. It occurs when there’s painful swelling in the growth plate in the heel. Doing the same movements over and over – like running and jumping – can cause this inflammation.

Sever’s disease is also called calcaneal apophysitis. Calcaneus is the medical term for the heel bone, and apophysitis refers to painful inflammation at the growth center at the end of a bone.

Sever's disease was first described by James Warren Sever, an American orthopedic physician, in 1912.

What are the signs and symptoms of Sever’s disease?

Sever’s disease can affect one or both heels. However, one heel is usually more painful than the other. Symptoms typically start when a child is between 8 and 14 years old.

Symptoms of Sever’s disease include:

• Musculoskeletal pain, tenderness and swelling in a heel

• Heel pain that worsens when running, jumping or participating in high-impact activities

• Heel pain that improves when sitting or lying down

• Limping or walking on tiptoes after physical activity

How is Sever’s disease diagnosed?

Sever’s disease causes symptoms similar to other overuse injuries like Achilles tendinitis and plantar fasciitis. An accurate diagnosis is critical to proper treatment and recovery. Our orthopedic specialists have deep expertise in diagnosing all types of overuse and sports injuries.

To diagnose Sever’s disease, our doctors:

• Perform a physical exam, including a “squeeze test” of the heel to check for pain and tenderness

• Evaluate symptoms

• Refer to images from an X-ray, MRI or ultrasoundto check for stress fractures, tendinitis and other injuries

What causes Sever’s disease?

Sever’s disease occurs when the Achilles tendon (a fibrous band of tissue connecting the calf muscle and heel bone) pulls on the growth plate in the heel. Growth plates are the soft tissue (cartilage) at the end of bones. This tissue hardens into bone when a child finishes growing. For a heel growth center, this typically occurs when a child is around 15 years old.

During a growth spurt, the bones in a child’s feet grow faster than muscles and tendons. The muscles and tendons stretch tight, limiting foot flexibility. When a child runs or the tight tendons pull on the heel’s growth center, this causes painful swelling. Repetitive impact landing on a hard surface can also lead to painful bruising of the growth center.

Factors that contribute to Sever’s disease include:

• Excess weight and obesity

• Flat feet or high arches

• Improperly fitted or unsupportive shoes

• Repetitive movements like running and jumping, especially on hard surfaces

• Tight Achilles tendon

How is Sever’s disease treated?

We offer a full range of treatments for Sever’s disease. Our orthopedic and sports medicine specialists develop a customized treatment plan that eases heel pain while helping athletes remain as active as possible.

Cushioned heel cups and physical therapyexercises to stretch and strengthen the calf muscle and Achilles tendon are the primary treatments for Sever’s disease. Athletes may work with physical therapists in our sports rehabilitation program.

Other treatments for Sever’s disease include:

• Applying ice to the heel

• Limiting or stopping pain-inducing activities

• Immobilization with walking boots

• Nonsteroidal anti-inflammatory drugs (NSAIDs)

• Orthotics, such as cushioned heel cups and inserts