Sever's disease

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Sever's disease
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The mucous sheaths of the tendons around the ankle. Lateral aspect. (Tendo calcaneus labeled at left.)
ICD-10 M92.6
ICD-9 732.5
DiseasesDB 11980

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Synonyms and Keywords: Calcaneal apophysitis; calcaneum osteochondrosis

Overview

Sever's disease, or calcaneal apophysitis, is the most frequent cause of heel pain in children between the ages of 8 and 13 and is due to an inflammation of growing plates, of the calcaneus in the back of the foot, due to the rapid growth of bone when compared to the calceneal tendon (otherwise known as the Achilles tendon).

Eponym

It is named for JW Sever, who characterized it in 1912.[1]

Causes

Sever’s disease is directly related to overuse of the bone and tendons in the heel. This can come from playing sports (i.e. football, basketball, lacrosse) or anything that involves lots of heel movements. It can be associated with starting a new sport, or the start of a new season.[2] Too much weight bearing down on the heel can also cause it as can excessive traction since the bones and tendons are still developing.

Prognosis

Sever’s disease is self-recovering, meaning that it will go away on its own when it is used less or when the bone is through growing. The condition is not expected to create any long-term disability, and expected to subside in 2-8 weeks.[3]

However, while the disease does subside quickly, it can recur, for example at the start of a new sports season, several times if it is not taken care of.

History and Symptoms

  • Complaints of pain or tenderness in the heel (or heels)
  • Discomfort upon awaking, or when heel is squeezed
  • Limping
  • More severe pain after walking and more difficulty walking
  • Pain during running or playing sports

Treatment

Treatment may consist of one or more of the following:

  • Stopping sports or other activities that aggravate the condition.
  • Elevating the heel
  • Stretching hamstring and calf muscles 2-3 times daily
  • In some cases, casting may be necessary
  • Using R.I.C.E. (Rest, Ice, Compression, Elevation)[3]
  • Stretching exercises
  • HTP Heel seats
  • In some cases medication may be needed (ask doctor)

Primary Prevention

  • Maintain good flexibility through stretching exercises
  • Avoid excessive running on hard surfaces
  • Use quality, well-fitting shoes with firm support and a shock-absorbent sole

Related Chapters

References

  1. Sever JW: Apophysitis of the Os Calcis. New York Medical Journal 1912; 95: 1025-1029.
  2. Hendrix CL (2005). "Calcaneal apophysitis (Sever disease)". Clinics in podiatric medicine and surgery. 22 (1): 55–62, vi. PMID 15555843. doi:10.1016/j.cpm.2004.08.011. 
  3. 3.0 3.1 However, while the disease does subside quickly, it can recur, for example at the start of a new sports season, several times if it is not taken care of.

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