Sever’s disease is a common cause of heel pain, particularly in the young and physically active. During puberty the calcaneus consist of two areas of bone known as ossification centres. These two areas are divided by an area of cartilage known as the calcaneal apophysitis. See x-ray (right) for two ossification centres of heel.
The Achilles tendon attaches the triceps surae (calf muscles) to the calcaneus (heel bone). As a child grows the calcaneus grow faster than the surrounding soft tissue, which means the Achilles tendon is pulled uncomfortably tight. This increase in tensile load can cause inflammation and irritation of the calcaneal apophysis (growth plate) which is known as Sever’s Disease. The pain is exacerbated by physical activities, especially ones involving running or jumping. Sever’s disease most commonly affects boys aged 12 to 14 years and girls aged 10 to 12 years, which corresponds with the early growth spurts of puberty.
Symptoms may include
- Unilateral or bilateral heel pain
- Heel pain during physical exercise, especially activities that require running or jumping
- Increased pain level after exercise
- A tender swelling or bulge on the heel that is painful on touch
- Calf muscle stiffness first thing in the morning
Treatment may include
- Stretching programs
- Strengthening exercises
- Exercise and training modification
- Orthotic therapy
In rare cases, where fragmentation of the apophysis exists and pain fails to subside with traditional treatments then immobilisation of the foot and ankle with a short leg pneumatic walker(walking cast) is indicated.