II. Epidemiology
III. Pathophysiology
- Low grade inflammation and Apophysitis at achilles tendon insertion
- Associated with irregular ossification
- Sclerosis of calcaneal apophysis
- Images
IV. Mechanism
- Traction injury of the achilles tendon insertion at the Calcaneus
V. Risk Factors
- Tight heel cord
- Running or jumping sports
- Early sports specialization
VI. Symptoms
- Heel Pain (often bilateral)
- Wearing shoes is painful (esp. soccer cleats)
- Ambulation is not painful (but weight bearing may exacerbate the pain)
- Pain is worse at the begining of a season or during a growth spurt
VII. Signs:
- Point tenderness over the achilles tendon insertion
-
Calcaneus inflammation
- Local pain
- Tenderness
- Swelling
- Tight heel cord
- Passive dorsiflexion of heel cord reproduces pain
- Pain worse with calcaneus Squeeze Test
- Medial and lateral compression of Calcaneus
VIII. Differential Diagnosis
IX. Imaging: Foot Xray
- Typically normal
- May demonstrate sclerosis of calcaneal apophysis
- However sclerosis also seen in normal, asymptomatic feet
- Evaluate for alternative diagnoses (e.g. Calcaneal Stress Fracture)
X. Management
-
General Measures
- NSAIDs or Acetaminophen
- Local heat
- Relative Rest
- Ice Therapy
-
Orthotics
- Padded heel cup
- Heel lift (1.25 cm)
- Diminishes heel cord stress
- Calf and Heel Cord StretchingExercises
- Focus on gastrocnemius muscle and soleus muscle Stretching
-
Short Leg Walking Cast (resistant cases)
- Foot in slight equinus (plantar flexion)
- Limit activity to pain free sports during recovery
XI. Course
- Anticipate return to activity within 6 weeks
XII. Prognosis
- Self limited condition with good overall prognosis
Images: Related links to external sites (from Bing)
Related Studies (from Trip Database) Open in New Window
| Concepts | Disease or Syndrome (T047) |
| ICD10 | M92.8 |
| SnomedCT | 156820001, 268124001, 23890000 |
| English | Osteochondritis of calcaneum, calcaneal apophysitis (diagnosis), juvenile osteochondrosis of calcaneum (diagnosis), juvenile osteochondrosis of calcaneum, calcaneal apophysitis, diseases sever's, sever's disease, Calcaneal apophysitis, Epiphysitis of os calcis, Juvenile osteochondrosis of calcaneum, Osteochondritis of the calcaneum, Sever's disease, Calcaneal apophysitis (disorder), calcaneo-apophysitis, calcaneus; apophysitis, Sever; osteochondrosis, Sever, osteochondrosis; Sever, apophysitis; calcaneus, Epiphysitis, os calcis, Osteochondrosis of calcaneum, Osteochondrosis of Sever |
| Italian | Malattia di Sever |
| Japanese | シーバー病, ｼｰﾊﾞｰﾋﾞｮｳ |
| Czech | Severova nemoc |
| Hungarian | Sever-betegség |
| Dutch | Sever; osteochondrose, apofysitis; calcaneus, calcaneus; apofysitis, osteochondrose; Sever, ziekte van Sever |
| Spanish | apofisitis calcánea (trastorno), apofisitis calcánea, enfermedad de Sever, epifisitis del calcáneo, osteocondritis del calcáneo, osteocondrosis juvenil del calcáneo, Enfermedad de Sever |
| Portuguese | Doença de Sever |
| French | Maladie de Sever |
| German | Sever-Krankheit |
