First off, Sever’s disease is not as scary as it sounds. In fact, it really shouldn’t be called a “disease” per se. Sever’s is very similar to a more well known condition, Osgood-Schlatter’s disease, which results in anterior knee pain. The process is the same except it occurs in the heel. Bones in young people have what are called growth plates or epiphyses. Bones also have secondary growth plates or apophyses which occur where tendons attach to bones. These growth plates occur throughout the body and are where growth of the bones occurs. If the achilles tendon pulls on the back of the heel and causes the apophysis to become inflamed it is known as Sever’s disease or calcaneal apophysitis. This results in swelling and pain in the back of the heel.
Sever’s disease most commonly occurs during the approximately 2 year period of quickest growth that occurs early in puberty. This growth spurt can start any time between ages 8 and 13 for girls and 10 and 15 for boys. This area of rapid growth often results in bones that are growing more quickly than muscles and tendons which tends to cause the muscles to put a lot of tension on the bones and in turn, on the growth plates. Sports, especially repetitive running or jumping sports that take place on hard surfaces are more likely to cause this painful condition. Standing for extended periods of time, which puts constant pressure on the heel is also an aggravating factor. Poor shoe choices can also exacerbate this condition. Wearing the right shoes can take pressure off of the achilles tendon and reduce the impact from running.
Signs and symptoms of Sever’s disease are all fairly straightforward. It usually involves pain and tenderness in the posterior heel and often includes swelling and redness. Often the pain will be severe enough to cause the patient to limp. The patient usually has a lot of pain if you squeeze each side of the heel.
Treatment of Sever’s disease is mostly focused on relieving pain. Ice is a good early option to help reduce the inflammation in the heel. Usually athletes are instructed to rest from their activity but not all athletes will have to sit out due to Sever’s. Stretching and home exercises are often utilized to lengthen out the calves. Active Release Technique is very useful to lengthen out the calves and the achilles to take pressure off of the bone. Various different compression sleeves, heel lifts, or arch supports may be useful based on a functional evaluation of the patients movement patterns.
Most athlete’s that suffer from Sever’s recover within 2 weeks to 2 months. If it is addressed early there is no risk of complications later in life. However, Sever’s disease can recur if appropriate measures such as rehabilitation, correcting footwear problems, and addressing biomechanical deficiencies are not taken. For more information about Sever’s, if you have questions, or to schedule an evaluation for your young athlete please contact our office.
Dr. Nolan Mitchell DC, CCSP, CSCS