Sever's Disease

(Calcaneal Apophysitis)

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What is Sever’s Disease and why does it occur

Sever’s Disease is stress and inflammation of the growth plate at the heel (calcaneus).  The site of the heel growth plate is right where the Achilles tendon (thick band of tissue just above your heel) attaches.  Patients are typically growing adolescents often in their growth spurt who are very active in running and jumping sports.  This results in significant force through the Achilles Tendon, which then pulls on the heel growth plate.

 

The rise of increased amount of sports and sports specialization in America has increased the incidence of overuse problems such as Sever's disease.  Unfortunately, many coaches and parents have advocated significantly increasing the amount of practice throughout the year.  While this potentially does improve an athlete’s skills, it does so at the expense of causing increased overuse injuries.  We clearly understand that there are significant pressures of potential college aspirations, perhaps parental pushing of the child, and just a child’s desire to get better at a sport.  However, this imbalance of over training an adolescent child to the point of injury remains one of the biggest problems we face in sports medicine.
 

Symptoms:

Patients usually present with posterior heel pain that may radiate into the Achilles tendon.  It is usually worsened with activity and decreases with rest.  However, in severe cases, however, pain may persist even at rest.
 

Diagnostic Testing

An x-ray is typically ordered to view the growth plate for evidence of widening or fracture and other bony pathology.  A Xray view of the other side is often obtained for comparison.  An MRI may be ordered to r/o stress fracture and further evaluate the Achilles tendon.

Treatment Options

Nonoperative treatment is first-line and primarily consists of activity modification.  Inflammation will only worsen if activities that cause pain are continued.  It is therefore extremely important to back down on these activities.  Patients who do not modify their activities end up worsening their condition and prolonging their recovery.  NSAID medications such as Advil or Aleve (so long as not contraindicated) may be recommended to help decrease inflammation.  Icing the affected area may also help decrease inflammation and pain.

 

Patients are usually prescribed physical therapy for a minimum of 6 weeks.  More severe cases will often be placed into a walking cam boot for improved immobilization and protection, and may remain in a walking boot for 6 weeks.

 

There is really no role for operative management in Sever’s Disease as pain almost always resolves once the heel growth plate closes.

 

*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables.  It is provided as an educational service and is not intended to serve as medical advice.  Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.

 

*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.  

© 2019 by Steven J. Lee, M.D. 

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