Sever disease, first described in 1912, is a painful inflammation of the calcaneal apophysis. It is classified with the child and adolescent nonarticular osteochondroses. (The other disease in this
group is Iselin disease, which is inflammation of the base of the fifth metatarsal.) The etiology of pain in Sever disease is believed to be repetitive trauma to the weaker structure of the
apophysis, induced by the pull of the tendo calcaneus (Achilles tendon) on its insertion. This results in a clinical picture of heel pain in a growing active child, which worsens with activity. Sever
disease is a self-limited condition; accordingly, no known complication exists from failure to make the correct diagnosis.
There are many contributing factors that cause strain across the growth plate, making your child prone to developing Sever?s disease. These include repeated minor trauma to the growth plate from
running or jumping sports, tight calf or hamstring muscles, rapid growth spurts can lead to the leg muscles becoming tight, increasing tension on the growth plate, tight Achilles tendon, the Achilles
tendon attaches to the back of the heel adjacent to the growth plate, poor foot posture, may increase the strain on the growth plate, footwear with a very low heel pitch (eg soccer boots),
unsupportive or unstable footwear with poor shock absorption at the heel, running or playing sport on hard surfaces.
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.
Physical examination varies depending on the severity and length of involvement. Bilateral involvement is present in approximately 60% of cases. Most patients experience pain with deep palpation at
the Achilles insertion and pain when performing active toe raises. Forced dorsiflexion of the ankle also proves uncomfortable and is relieved with passive equinus positioning. Swelling may be present
but usually is mild. In long-standing cases, the child may have calcaneal enlargement.
Non Surgical Treatment
Primary treatment involves the use of heel cups or orthotics with a sturdy, supportive plastic shell. Treatment may also include cutting back on sports activities if pain interferes with performance,
calf muscle stretching exercises, icing, and occasionally anti-inflammatory medications. Severe cases may require the short term use of a walking boot or cast.
Exercises that help to stretch the calf muscles and hamstrings are effective at treating Sever's disease. An exercise known as foot curling, in which the foot is pointed away from the body, then
curled toward the body in order to help stretch the muscles, has also proven to be very effective at treating Sever's disease. The curling exercise should be done in sets of 10 or 20 repetitions, and
repeated several times throughout the day.