Calcaneal Apophysitis (Sever's Disease)

UW Health's Sports Medicine doctors treat a wide range of common athletic injuries.

Calcaneal apophysitis (Sever’s disease) is the most common cause of heel pain in young athletes.

Calcaneal apophysitis is a painful inflammation of the heel’s calcaneal apophysis growth plate, believed to be caused by repetitive microtrauma from the pull of the Achilles tendon on the apophysis. Patients with calcaneal apophysitis may have activity-related pain in the posterior aspect of the heel. 60 percent of patients report bilateral pain. This condition is usually treated conservatively with stretching and arch supports. The young athlete should be able to return to normal activities as the pain decreases. Calcaneal apophysitis (Sever’s Disease) may last for months. Increasing pain, despite measures listed below, warrants a return visit to the physician.

Signs and Symptoms

• Heel pain on one or both sides
• Heel pain with running, jumping and other sport related activities
• Limping
• Pain elicited when the heel is squeezed

Causes

• Sports with repetitive impact
• Poorly cushioned footwear
• Tight lower leg muscles, primarily the achilles tendon and the calf
• Normal growth pattern when the bones often grow faster than the muscles and tendons

Treatment

• Modify sporting activities as needed based on pain
• Ice after activity
• Stretch hamstrings, calf, and achilles tendon
• Evaluate for orthotics, arch supports and/or new shoes
• Heel cups or non-custom arch supports for cushioning of the heel
• Avoid going barefoot
• Anti-inflammatory medication may be prescribed by a physician

References

Cassas, KJ, Cassettari-Wayhs, A. Childhood and adolescent sports-related overuse injuries. American Family Physician. 2006;73(6): 1014-22.

DeLee, JC, Drez, D, Miller, MD. Orthopedic Sports Medicine. Vol 2; 2003: 2389-2390.

Fryman, Edward. Quality Foot Care For the Entire Family www.seafordfootcare.com. Accessed October, 2006.

Hendrix, CL. Calcaneal apophysitis (Sever disease). Clinics in Podiatric Medicine and Surgery. 2005;22(1): 55-62.

ICB Medical. Children’s Heel Pain (Sever’s Disease). www.icbmedical.com. Accessed October, 2006.

University of Michigan Health System, Calcaneal Apophysitis (Sever’s Disease). www.med.umich.edu. Accessed September, 2006.