Sever's disease
Sever's disease, also known as calcaneal apophysitis, is a common cause of heel pain in growing children and adolescents. This condition, often seen in young athletes, occurs when the growth plate of the calcaneus (heel bone) becomes irritated and inflamed due to repeated stress and overload. Sever's disease generally presents as heel pain that worsens with walking, running, or playing sports. Although temporary, this condition can be particularly troublesome and limit the daily activities of young patients.
What is Sever's disease?
Sever's disease is a growth plate apophysitis, which corresponds to pain in the growth plate at the level of the posterior tuberosity of the calcaneus. Sever's disease is a pediatric condition, occurring in children aged 8 to 15 years, and affects boys more frequently.
Symptoms of Sever's disease
The main symptom is heel pain, of mechanical nature. This pain subsides with rest and increases with physical activity.
Palpation and manual pressure of the calcaneal tuberosity reproduce the pain.
The diagnosis of Sever's disease
The diagnosis is clinical. Sever's disease can appear in young athletes, or in children with a shortening of the posterior muscle chains. It is necessary to rule out plantar fasciitis, a retrocalcaneal bursitis or a Haglund-type conflict, or Achilles tendinopathy. The shortness of the Achilles tendons can be responsible for heel pain.
In case of fever or a recent infectious episode, it is necessary to rule out a serious condition, osteomyelitis, which can cause long-term growth disturbances. Heel pain may be unilateral or bilateral, and children may walk on tiptoe to relieve painful tension.
Impact sports promote Sever's disease, 87% of children participating in these sports experience heel pain, particularly in cases of:
- inadequate sports equipment
- inappropriate footwear for the sport practiced
- overweight
Imaging assessment
X-rays of the ankles and feet are part of the evaluation for Sever's disease; they can show irregularity of the growth plate, a very white tuberosity indicating tension at the junction of the Achilles tendon insertion and the plantar aponeurosis, as well as fragmentation of the apophysis. MRI may show edema at the level of the calcaneus.
What are the treatments for Sever's disease?
The treatment is symptomatic, it involves:
- rest from sports during the painful period
- stretching of the posterior muscle chains
- rehabilitation with eccentric contraction exercises of the triceps surae (Stanish method).
Physiotherapy
It consists of stretching the posterior muscle chains, especially the gastrocnemius and hamstrings.
The Mézières method may be suggested despite the young age of the patients,
Homeopathy
Magnesium may be recommended for its relaxing properties, and it is also necessary to have sufficient daily hydration.
Insoles and orthotics
Insoles and orthotics must be shock-absorbing to relieve heel impact. They are complementary to rehabilitation.
Surgery for Sever's disease
The treatment is medical; it is extremely rare to suggest surgery. Very occasionally, it is possible to propose a lengthening of the Achilles tendon if it is too short.
FAQ
It is necessary for athletic children to warm up before a sports session and to stretch afterwards. Equipment must be suited to the sporting activity.
Cushioning insoles and heel pads can relieve pain, but it is necessary to stretch the posterior muscle chains.
Cushioned shoes such as running shoes are effective for pain relief.
It can last several months despite proper treatment.
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