Sever’s disease
(Calcaneal Apophysitis)

What is Sever’s disease?

Sever’s disease, also called Calcaneal Apophysitis or os calcis osteochondritis, is an inflammation of the growth plate in the heel and it is one of main cause of heel pain in children.

Sever’s disease mainly affects boys aged between 9 and 13 years old, when bones are still developing. In most case pain is bilateral and spreads toward the Achilles tendon.

What causes Sever’s disease?

Sever’s disease is often associated with a rapid growth spurt and can be caused by

• a functional overload of the back of the heel (back foot) due to morphological alterations of the bone structure (cavus foot in particular).
• sports that imply excessive loads (i.e. sports that involve running and jumping, especially on hard surfaces, such as track, basketball, soccer, and gymnastics.)

Usually during the growth spurt bones may grow faster than muscles and tendons and this can cause the muscles and tendons to become tight and overstretched.

What happen in these situations is that the Achilles tendon, which is the strongest tendon attached to the growth plate in the heel, becomes overstretched and inflamed.

Sever’s disease symptoms

The main symptom is heel pain that gets worse during activity and tends to disappear with rest.

The pain may also spread toward the sides and bottom of the heel and the Achilles tendon.

Children may also have other problems such as:

• swelling
• discomfort when the heel is squeezed
• walking on tiptoes to avoid putting pressure on the heel or on the contralateral limb

How is Sever’s disease diagnosed?

Diagnosis is based on a careful clinical evaluation and on the symptoms reported by the child.

Although imaging tests such as X-rays generally are not that helpful in diagnosing Sever’s disease, some doctors order them to rule out other problems, such as fractures, bone cysts, etc.

Sever’s disease treatments

Therapy depends on symptoms and its goal is pain relief.

In mild cases the doctor suggests the use of a soft silicones heelpiece and cut down or rest from sport activities.

If rest is not enough to reduce pain and other symptoms, the doctor may suggest anti-inflammatory drugs and avoid sport activities for two months.

Be careful not to ignore pain! Going on practising sport stoically can lead to permanent calcifications that require surgical removal.

Why choose Professor Portinaro

Prof. Portinaro is one of the most qualified surgeons in the world for foot diseases and treatments.

In his long-running career he has been treating non surgically around 3000 patients affected by Sever’s disease.