Symmetry Blog

Severs Disease

Symmetry Physio - Tuesday, September 05, 2017
A common cause of heel pain in active injury.



Sever's Disease

What is Severs disease?


Sever’s disease is a common cause of heel pain in the active child. It is also known as calcaneal apophysitis because it is a condition that affects the growth plate (apophysis) of the heel bone (calcaneum).

A growth plate is located at the ends of some of our bones during childhood and adolescence. It allows our bones to grow and get longer. They are made up of cartilage, a more flexible, less stable material than bone. An x-ray of the heel will clearly show the growth plate which can often be confused as a fracture by concerned parents (see image to right). The growth plate will ossify (or harden) when the bones are fully grown. For boys, this can happen anywhere between 15 & 17 years old, whereas girls tend to reach skeletal maturity slightly earlier between 13 & 15 years old.

What causes Severs disease?

MRI studies have shown us that Sever’s is a chronic (or repetitive) load injury to the deep structures of the bone that is not yet fully mature. This can cause damage to the developing bone and inflammation can occur. This means that the amount of training for certain activities or sports are not being tolerated by the young growing bone and pain occurs. Although less common, there are some children who can suffer from Sever’s disease that do not play sport and aren’t very active. This usually means that other predisposing factors such as a foot or leg biomechanics will likely be the main contributor.

What are the symptoms?

A child will usually complain of activity related heel pain that is often around the Achilles tendon but can also be spread around the ankle. You may notice them limping while walking or running.

How is it Diagnosed?

Usually, the history and symptoms are enough to make us suspicious of Sever’s, especially in the age brackets described above. We also have some tests that can help us confirm the diagnosis. During our examination, we will also look at foot and leg biomechanics to determine if any weakness, stiffness, or tightness could be contributing to the overload.

What is the treatment?

Initially, treatment involves rest from aggravating activities or sports until the pain settles. A heel raise can be inserted into shoes to help with this initial phase. Treatment will consist of massage, stretching and joint mobilisations. Once pain-free, some strengthening exercises for the ankle, foot, and calf should be given by your physiotherapist. Any biomechanical faults found in our initial examination will be addressed. Gradually, sports and activities can be reintroduced only if there is still no pain.

Severs is a self-limiting condition, meaning it will resolve with rest and appropriate strengthening. If you feel that your child may have Sever’s it is important to get the appropriate advice from one of our trained physiotherapists.

The Team at Symmetry Physiotherapy


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