Sever Disease

Key Features

• Also called calcaneal apophysitis

• Occurs in athletes aged 8–12 years who are typically involved in high-impact activities, such as gymnastics and soccer

• Causes

  • Overuse

  • Improper footwear

  • Tightness in the calf musculature and Achilles tendon

Clinical Findings

• Pain occurs about the heel and at the point of muscle tendon insertion onto the growth center of the calcaneus

• Athlete complains of activity-related heel pain

• Examination reveals focal tenderness over the calcaneal apophysis

• Tenderness created by pressing forcefully on the lateral and medial heel constitutes a positive "calcaneal squeeze test"

Diagnosis

• Clinical

Treatment

• Symptomatic

  • Reassurance and education

  • Relative rest

  • Heel cord stretching

  • Eccentric calf strengthening

  • Ice massage

  • Heel cups

  • Nonsteroidal anti-inflammatory drugs for pain control

  • Progression to activity as tolerated based on pain level

• Activity restriction is not required

• Refractory cases may benefit from brief immobilization and partial or non–weight bearing in a walking boot or cast followed by supervised physical therapy