Sever’s Disease

Courtesy: Prof Nabile Ebraheim, University of Toledo, Ohio, USA

 

• Severs disease is a common cause of heel pain in children between the age of 9-12 years
• The pain is due to calcaneal apophysitis due to continuous and repetitive traction on the calcaneus from the Achilles tendon
• Severs disease is similar to osgood schlatter disease of tibial tubercle
• It is important to remember that apophysis is not the epiphysis
• The apophysis is not part of the joint and has muscle and/or tendon attachments
• This traction apophysitis may lead to stress fractures, pain and tenderness over heel
• Patients are usually young athletes presenting with heel pain that increases with activities

Examination:

• There could be swelling, tenderness, warmth and or redness on the back of the heel where the Achilles tendon inserts

Radiology:

• Plain lateral x-rays may show sclerosis or fragmentation of the calcaneal tuberosity
• Sclerosis is not specific for this condition
• Fragmentation of the calcaneal tuberosity on the other hand is more common in patients with sever’s disease relative to general population
• Sever’s disease is a clinical diagnosis

Xrays may show other causes of pain such as tumors, infection, fractures or cysts

MRI is not used but can help to rule out calcaneal stress fractures or osteomyelitis

Prognosis:

• Sever’s disease is a self limiting condition which usually resolves with time.

Treatment-
– [ ] NSAIDs
– [ ] Achilles tendon stretching exercises
– [ ] Activity modifications
– [ ] Short leg walking cast if the condition is severe