Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Sep 19 2023

Sever's Disease

  • summary
    • Sever's Disease is a common idiopathic condition caused by overuse injury of the calcaneal apophysis in a growing child that presents with posterior heel pain. 
    • Diagnosis is made clinically with tenderness over the calcaneal apophysis with foot radiographs showing sclerosis and fragmentation of the calcaneal apophysis. 
    • Treatment is usually activity modifications, stretching of the heel cord and NSAIDs as the condition typically resolves over time. 
  • Epidemiology
    • Demographics
      • commonly seen in immature athletes participating in running & jumping sports
        • frequently seen just before or during peak growth
  • Etiology
    • Mechanism
      • exact etiology is unknown
      • thought to be due to traction apophysitis and repetitive microtrauma experienced during gait (similar to Osgood Schlatter's Disease)
  • anatomy
    • The calcaneal apophysis experience significant force from combination of both
      • direct impact onto the heel during the heel strike phase of gait
      • opposing tension forces generated by the plantar fascia and the pull of the gastrocsoleus complex
  • Presentation
    • Symptoms
      • pain in the area of the calcaneal apophysis in an immature athlete
      • pain increased with activity or impact
      • stretch of the triceps surae exacerbates heel pain
      • can display warmth, erythema, & swelling
    • Physical exam
      • tight Achilles tendon
      • positive squeeze test (pain with medial-lateral compression over the tuberosity of the calcaneus)
      • pain over the calcaneal apophysis
  • Imaging
    • Radiographs
      • diagnosis is clinical as there is no established diagnostic criteria
      • sclerosis can be present in both patients with and without calcaneal apophysitis
      • fragmentation is more frequently seen in patients with Sever's disease
      • helpful to rule out other causes of heel pain (osteomyelitis, calcaneal bone cysts)
    • MRI
      • can help localize inflammation to apophysis
      • can rule out disorders of the body of the os calcis (stress fracture, lytic lesion, osteomyelitis)
    • Other
      • bone scan can show increase uptake at the apophysis, but is typically not helpful in diagnosis
  • Treatment
    • Nonoperative
      • symptomatic treatment
        • modalities include
          • activity modification
          • Achilles tendon stretches (can help decrease recurrence)
          • ice application before and after athletic endeavors
          • use of heel cups or heel pads
          • NSAIDs
          • short leg cast immobilization of persistent pain
        • outcomes
          • recurrence is common
    • Operative
      • there is no role for operative treatment
  • Prognosis
    • Natural history
      • self-limiting entity that resolves with maturation and the closure of the apophysis
1 of 3
1 of 6
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options