Conditions & Treatments - Sever's Disease / Calcaneal Apophysitis

Sever’s disease is a condition commonly associated with overuse much like Osgood-Schlatter disease (1). It is regularly found in children and involves inflammation of the calcaneal apophysis, the site where the Achilles tendon inserts onto the calcaneus (1, 2, 3). Within this site is a growth center which consists of cartilage that are secondary centers of ossification (1, 2). This area is often irritated as a result of repetition which results in trauma to the bone-cartilage junction of the skeletally immature child (1, 2). This condition most often occurs in children between 7 to 15 years of age with more frequent findings in females between 8 and 10 years of age and in males between 10 and 12 years in age (1). The onset of a growth spurt or the beginning of a new sport season are associated periods of time when a child may develop this condition (1, 2, 3). Participation in athletics or play which involves running, sprinting, hopping, or jumping could contribute to this condition as well (1, 2). Over time, the condition will usually go away on its own once the bone has matured (1, 2).

Symptoms of Sever’s Disease or Calcaneal Apophysitis
Children that have Sever’s Disease will complain of posterior heel pain at the region of the calcaneal apophysis. The onset of pain is usually gradual which can be exacerbated with weight-bearing activities to the point where the child may limp and is unable to participate in physical activities (1, 2, 3). Rest of the involved extremity along with participation in physical therapy may provide relief from symptoms in 2–8 weeks (3).

Physical Therapy Findings in Patients’ with Sever's Disease
Often times children that present with Sever’s disease will display pain and tenderness at the region of the heel, limited ankle joint dorsiflexion, over pronation of the foot, and increase pain with weight-bearing activities (1, 2, 3). Radiographs are not effective for diagnosing this condition but can be utilized to rule out other potential pathologies (1, 2, 3). However, a diagnostic test that involves medial-lateral compression of the calcaneus in the area of the growth plate will elicit pain in individuals with Sever’s disease (2, 3).

Sever's Disease/Calcaneal Apophysitis Treatment Options for a PT
• Rest
• Postural/Functional Training
• ROM exercises (see video 03a & 03b for lower leg/ankle/foot)
• Stretching (see videos 8, 9 & 10 for lower leg/ankle/foot)
• Strengthening/Stabilization (see video 2 for lower leg/ankle/foot)
• Manual Therapy
• Modalities (ice, ultrasound/phonophoresis/iontophoresis/ketoprfen gel)
• Obtain heel lift, heel cups, UCBL orthotic

Last revised: May 18, 2012
by Chai Rasavong, MPT, MBA

References
1) White R. Ketoprofen Gel as an Adjunct to Physical Therapist Management of a Child with Sever Disease. Physical Therapy. 2006;86:424-433.
2) Scharfbillig R, et al. Sever's Disease: What Does the Literature Really Tell Us? Journal of the American Podiatric Association. 2008;98(3):212-223.
3) Madden CC, et al. Sever's disease and other causes of heel pain in adolescents. Am Fam Physician. 1996 Nov 1;54(6):1995-2000.