Sever disease

Sever disease refers to a calcaneal apophysitis (an inflammation of the apophysis of the heel)  which occurs in children and young adolescents.

Epidemiology

It typically presents in active young children (especially ones who engage in jumping and running sports). 

Pathology

The condition is thought to result from repetitive microtrauma to growth plates of the calcaneus. However, some of the recent articles say there is no evidence that weight and activity levels are risk factors for Sever disease 6.

Associations

High plantar foot pressures are associated with Sever disease, although it is unclear whether they are a predisposing factor or a result of the condition. Gastrocnemius equinus may be a predisposing factor for Sever disease 7.

Clinical presentation

Patients tend to present with posterior heel pain which is usually aggravated by physical activity such as walking, running or jumping.

Radiographic features

Sever disease is most often diagnosed clinically, and radiographic evaluation is believed to be unnecessary by many physicians, but if a diagnosis of calcaneal apophysitis is made without obtaining radiographs, a lesion requiring more aggressive treatment could be missed 4.

Plain film

Foot radiographs are usually normal and the radiological identification of calcaneal apophysitis without the absence of clinical information was not reliable 9.

MRI

May show oedematous changes within the calcaneal apophysis, possibly extending into the adjacent calcaneal tuberosity 10.

Treatment and prognosis

The condition is self-limiting with brief limitation of activity sometimes being advocated. Common advice is to reduce physical activity 8.

History and etymology

It is named after Dr J W Sever, American (US) physician 1.

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Article Information:

rID: 10681
System: Musculoskeletal
Tag: cases
Synonyms or Alternate Spellings:
  • Sever's disease
  • Calcaneal apophysitis
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