Also known as calcaneal apophysitis, Severs? disease is a condition that primarily affects children between the ages of 7 and 15. The condition is typified by pain in the heel which can affect
movement, and as a foot condition, comes under the care of podiatrists. Podiatrists are specially trained professionals who specialise in any and all ailments of the foot and ankle. Podiatrists
dealing with Severs? disease are typically podopaediatricians, individuals who have received training in the delivery of childhood care.
Sever?s is often present at a time of rapid growth in adolescent athletic children. At this time the muscles and tendons become tighter as the bones become larger. Between 8 - 15 years of age is the
usual onset of this condition.
The typical clinical presentation is an active child (aged 9-10 years) who complains of pain at the posterior heel that is made worse by sports, especially those involving running or jumping. The
onset is usually gradual. Often, the pain has been relieved somewhat with rest and consequently has been patiently monitored by the patient, parents, coaches, trainers, and family physicians, in the
expectation that it will resolve. When the pain continues to interfere with sports performance and then with daily activities, further consultation is sought. It should be kept in mind that failure
to instruct patients and parents that continual pain, significant swelling or redness, and fever are not signs of Sever disease and therefore require further evaluation could result in failure to
diagnose a condition with much more serious long-term consequences.
To diagnose the cause of the child?s heel pain and rule out other more serious conditions, the foot and ankle surgeon obtains a thorough medical history and asks questions about recent activities.
The surgeon will also examine the child?s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.
Non Surgical Treatment
In mild cases, elevating the heel through heel lifts in the shoes and decreasing activity level may be enough to control the pain. In more severe cases, orthotic therapy to help control the motion of
the heel, as well as icing, elevating, and aspirin therapy may be required to alleviate the symptoms. In those children who do not respond to either therapy mentioned above, it is sometimes necessary
to place the child in a below-knee cast for a period of 4-6 weeks. It is important for both the child and parents to understand that the pain and swelling associated with this disorder should resolve
once the growth plate has fused to the primary bone in the heel.