Sever’s Disease: Recognizing Symptoms, Treatment Strategies, and Risk Considerations

Sever’s disease is an overuse injury caused by heel bone irritation. Its symptoms range from tenderness to a limp, making distinguishing it from other foot problems difficult. The silver lining is that it resolves on its own in almost no time. However, treatment and exercise can significantly help.

Sever’s disease — calcaneal apophysitis — is irritation of the heel bone. It causes pain and swelling in the growth plate where your tendon connects to the back of your heel. As a result, it mainly affects children and adolescents.

When you’re young, you have several pieces of cartilage between your bones called growth plates. Eventually, they are replaced by solid bone during skeletal maturation. However, until then, they are weaker than the nearby ligaments and tendons, making them vulnerable to injury.

The back of your heel bone is circular. It has a superior, middle and inferior facet. The middle provides an attachment site for your calcaneal tendon. You probably know this tendon by the name “Achilles tendon.” This tough, fibrous cord of tissue connects your calf muscle to your calcaneus — your heel bone — enabling you to walk, run, jump and climb.

Despite its name, Sever’s disease is technically not a disease. Rather, it is categorized as an overuse injury because it can be brought on by heavy physical activity. It’s named after the physician who first described it in the 1900s.

How long does apophysitis of the heel last? While you should expect it to last around two to three months, it can return over a several-year span in some people. If you get it once, you might get it again. However, it shouldn’t be an issue once you reach adulthood and your growth plates are replaced with solid bone.

How do you know if you have calcaneal apophysitis? Many injuries can affect the area around your Achilles tendon. To be sure, you must identify the signs.

Here are the most common Sever’s disease symptoms:

• Tenderness: Your heel feels tender to the touch. This increased sensitivity may make the pain feel worse.
• Activity-induced pain: Pain that worsens with activity — especially in high-impact sports like gymnastics or cross-country — is a sign of apophysitis of the heel.
• Inflammation: Redness, swelling and irritation in the heel are some of the earliest symptoms of Sever’s disease.
• Walking problems: People with this injury tend to limp or walk on their tiptoes to avoid bearing weight on the affected foot, affecting their gait.

One or both of your feet may be affected. Up to 60% of people who get this injury experience pain in both. While dealing with the extra pain isn’t exactly ideal, it can help you and your doctor narrow down the cause of your symptoms.

Only a medical professional can give you a Sever’s disease diagnosis. To your untrained eye, your predicament may seem pretty cut and dry. However, problems like tendonitis and bone fractures present with similar symptoms. Visit a physician to ensure your diagnosis is accurate.

Since this overuse injury is among the most common reasons for heel pain in children and adolescents, doctors know what to look for. However, they need to be sure to prevent a misdiagnosis. They will likely conduct a squeeze test or take an X-ray of the area.

Treating Sever’s disease symptoms is crucial. While children and adolescents will outgrow this overuse injury in two to three months, treatment reduces their pain, allowing them to continue taking part in the activities and sports they love.

Plus, while apophysitis of the heel doesn’t lead to long-term damage, it could have lasting consequences if left untreated. Children who walk funny to avoid bearing weight on the affected heel could develop an abnormal gait or a muscle imbalance. Luckily, there are multiple effective treatment options.

Stretching the Achilles tendon and calf muscles is an excellent treatment exercise for Sever’s disease. Doing so can relieve pressure on the growth plate, improving mobility and relieving pain.

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are available over the counter in many countries. They reduce pain and swelling, helping children walk correctly and participate in more physical activities.

Rest, ice, compression and elevation can reduce inflammation and pain. Time spent on the couch with a cold pack is an excellent alternative to NSAIDs.

Running and jumping shouldn’t be part of a child’s routine until they recover because they are risk factors for apophysitis of the heel. If kids still want to take part, warm-ups can help them get in better shape.

However, rest is best. They do have an overuse injury, after all. They should stick to Sever’s disease treatment exercises if they want to remain active.

Special shoe inserts, compression socks, athletic tape and supportive footwear can help kids walk without pain. They also encourage healing, potentially accelerating recovery.

Apophysitis of the heel only occurs in children and adolescents. It’s particularly prevalent in children who are 8 to 15 years old, making them the most at-risk group. However, some behaviors and characteristics can raise the risk of developing this overuse injury.

Since calcaneal apophysitis affects the growth plates, growth spurts are a risk factor. Muscles, tendons, cartilage and bones grow unusually quickly during these periods, causing soft tissue and bone to shift. They become more vulnerable to injury, especially when running or jumping.

On the bright side, growth spurts make identifying this overuse injury easier because there are early warning signs.

A restrictive caloric diet is a commonly overlooked risk factor. During growth spurts, kids’ bones need adequate levels of vitamins, minerals and amino acids. Without a nutrient-rich diet, children are more prone to growth plate injuries. However, the opposite is true, too. Having a greater body mass index is not ideal. Childhood obesity is a significant risk factor.

A child with calcaneal apophysitis may be fussy and easily aggravated because they experience pain with almost every step. Getting them rest, easing their pain and putting them on a nutrient-rich diet can help you manage their pain and emotions.