Sever’s Disease Posted on Thursday, September 11, 2003 - 00:00 Synonyms: Traumatic calcanial apophysitis Cause; This is an overload injury occurring in children. Excessive traction on the calcanial apophysis gives rise to the problem. Sports: In all sports where sprinting and jumping are major features, e.g. athletics Incidence: - Common in the 9-12 age group Found more commonly in boys than girls Barefoot runners are especially vulnerable In cases of delayed puberty, Sever’s disease may occur as late as 16 years old. Pathology: Excessive traction of the calf musculature on the apophysis, between the posterior portion of the calcaneus and the main body of the calcaneus, causes the pain symptoms. Symptoms: Pain is found at the back of the heel, and occurs during sport, but is at its worst after the patient has rested following sporting activity. This causes the young patient to limp Similar features may be found on awakening Signs: - Side-to-side compression of the back of the calcaneus will cause the pain Direct pressure on the posterior portion of the calcaneus is usually not painful. Investigations: X-rays There are no specific features radiologically. Sclerosis and fragmentation of the posterior portion of the calcaneus as is sometimes described occurs in normal heels as well. Differential In the 9-12 age group, except for unusual conditions such as Diagnosis: infection or tumour, a pain in the back of the heel is usually Sever’s disease. Prevention: Coaches should be prevented from placing unfit children on a vigorous sprinting or jumping programme Treatment: Mild Cases Heel elevation Reduction of activity Non-steroidal anti-inflammatory drugs will usually assist the child in continuing with sport Severe Cases Rest from an overloading activity will often allow the condition to settle in 4-6 weeks. The problem, however, may again return on excessive activity. Article by: Dr Clive Noble (SARFU Medical Committee Member)