Sever’s (apophysitis of the calcaneus) is a condition affecting the growth plate of the calcaneus where the Achilles tendon inserts. Commonly during adolescent growth spurts, inflammation occurs with traumatic disruption of the growth plate at the calcaneus insertion of the Achilles tendon. It is self limiting and stops after fusion of the growth plate.

Injury mechanism:

• In a growing adolescent (5-11 years) with intact calcaneus growth plate, repetitive loading to the calcaneus causes inflammation and injury to the growth plate due to the forcible pull of the Gastrognemius tendon during increasing activities like running and jumping. This leads to cartilage damage, thickening and fragmentation of the calcaneus at the Achilles tendon insertion.

Severs disease: Inflammation with injury to the Achilles tendon insertion to calcaneus

• Heel pain at the calcaneus Achilles tendon insertion site
• Swelling
• Palpable defect
• Painful dorsiflexion movement especially while lift off and landing during jumping

Heel pain. Sever’s disease have pain at calcaneus growth plate.

X-rays:

• Ossicle in the Achilles tendon.

Ultrasound:

• Achilles tendon swelling with disruption and fragmentation of the Achilles growth plate with Achilles tendon thickening with associated bursa swelling

Nonoperative:

• Analgesia: Nonsteroidal ant-inflammatory drugs (NSAIDs)
• Ice over affected area for 15 minutes several tines a day
• Rest
• Heel pad
• Stretching of Gastrognemius/Soleus complex
• Cast immobilization a consideration for persistent pain

Surgery:

• Not indicated

Gastrognemius stretching

Soleus stretching

Intrinsic foot strengthening