Review Question - QID 217348

Most common in young jumping-sport athletes, Sever's disease is apophysitis of the calcaneus secondary to Achilles tendon traction and microtrauma.

Sever's disease is a pathology that presents most often as posterior heel pain in jumping or running sport athletes and is seen just before or during peak growth. Its etiology is thought to be traction apophysitis of the calcaneus secondary to pull of the Achilles tendon and repetitive microtrauma. Treatment is conservative with anti-inflammatory medications, activity modification, Achilles stretching, and use of heel cups. Refractory cases may benefit from short leg cast immobilization. There is no role for operative intervention in these patients. Overall the disease process is self-limited and resolves with skeletal maturity and physeal closure.

James et al. published a systematic review looking at interventions for pain control and maintaining activity in Sever's disease patients. They found that heel cups and lifts significantly decreased pain in multiple studies. However, they found limited reporting on other conservative measures to include icing, stretching, and NSAIDs, and therefore could not provide definitive recommendations on the use of these modalities.

Launay et al. published a review article detailing multiple sports-related overuse injuries in children involving both upper and lower extremity joints. Sever's Disease (or osteochondrosis of the calcaneus) is described as a result of repetitive traction of the Achilles tendon on the secondary ossification center of the calcaneus. Clinically it occurs most often in boys between 8 and 12 years of age, bilateral, and asymmetric in symptoms. Treatment is a brief suspension of athletic activities, stretching, and orthotics.

Figure A demonstrates a lateral of the foot of a skeletally immature patient with classic radiographic findings of sclerosis and fragmentation of the calcaneal apophysis.

Incorrect answers:
Answer 1: While minimal information is given in the prompt about infection symptoms or labs, the prescribed treatment without antibiotics makes this an incorrect answer.
Answer 2: Compression of the first branch of the lateral plantar nerve (Baxter's Nerve) results in pain similar to plantar fasciitis along the arch of the foot.
Answer 3: Inflammation of the plantar fascia insertion would result in point tenderness at the anterior aspect of the heel pad without pain on heel squeeze.
Answer 5: Tarsal tunnel syndrome is compression of the tibial nerve and presents with neuropathic medial ankle and plantar foot pain.