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Calcaneal Apophysitis

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Calcaneal Apophysitis, Sever's Disease, Sever Disease, Calcaneoapophysitis, Apophysitis of the Achilles Tendon

  • See Also
  • Epidemiology
  1. Occurs most commonly in boys, ages 8 to 14 years
  2. Most common cause of Heel Pain in children and Teens
  3. Associated with Running or jumping sports (esp. early season or at times of growth spurt)
    1. Basketball
    2. Soccer
    3. Track
  • Pathophysiology
  1. Low grade inflammation and Apophysitis at achilles tendon insertion
  2. Associated with irregular ossification
    1. Sclerosis of calcaneal apophysis
  3. Images
    1. ankleLateralSevers.jpg
  • Mechanism
  1. Traction injury of the achilles tendon insertion at the Calcaneus
  • Risk Factors
  1. Tight heel cord
  2. Running or jumping sports
  3. Early sports specialization
  • Symptoms
  1. Heel Pain (often bilateral)
  2. Wearing shoes is painful (esp. soccer cleats)
  3. Ambulation is not painful (but weight bearing may exacerbate the pain)
  4. Pain is worse at the begining of a season or during a growth spurt
  • Signs
  1. Point tenderness over the achilles tendon insertion
  2. Calcaneus inflammation
    1. Local pain
    2. Tenderness
    3. Swelling
  3. Tight heel cord
    1. Passive dorsiflexion of heel cord reproduces pain
  4. Pain worse with calcaneus Squeeze Test
    1. Medial and lateral compression of Calcaneus
  1. Typically normal
  2. May demonstrate sclerosis of calcaneal apophysis
    1. However sclerosis also seen in normal, asymptomatic feet
  3. Evaluate for alternative diagnoses (e.g. Calcaneal Stress Fracture)
  • Management
  1. General Measures
    1. NSAIDs or Acetaminophen
    2. Local heat
    3. Relative Rest
    4. Ice Therapy
  2. Orthotics
    1. Padded heel cup
    2. Heel lift (1.25 cm)
      1. Diminishes heel cord stress
  3. Calf and Heel Cord StretchingExercises
    1. Focus on gastrocnemius muscle and soleus muscle Stretching
  4. Short Leg Walking Cast (resistant cases)
    1. Foot in slight equinus (plantar flexion)
  5. Limit activity to pain free sports during recovery
  • Course
  1. Anticipate return to activity within 6 weeks
  • Prognosis
  1. Self limited condition with good overall prognosis