SEVER DISEASE (CALCANEAL APOPHYSITIS)

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Sever disease is common cause of heel pain among active young people. The mean age of presentation for girls is about 9 years of age and for boys about 11 to 12 years. Approximately 60% of cases are bilateral. Sever disease is caused by the forces of the calf musculature through the Achilles tendon at the calcaneal apophysis, causing microfracture. As the child ages and the apophysis begins to close, the pain disappears.

Clinical Manifestations

The common presentation is a young athlete who develops heel pain with activity which decreases with rest. There is rarely swelling, but there may be limping associated with Sever disease. The child will have pain to palpation of the posterior calcaneus and often tight heel cords. Radiographs are rarely indicated, but with persistent pain they should be done to exclude infection or tumor.

Treatment

Activity modification, icing, and anti-inflammatory medications can be helpful. A program designed to improve heel cord flexibility and overall ankle strength may decrease symptoms. Heel elevation using heel wedges or heel cups can be helpful.

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