Sever’s disease (also known as calcaneal apophysitis) is a musculoskeletal condition characterised by inflammation of the cartilaginous growth plate of the calcaneus. It is a tractional apophysitis where a painful inflammatory response is caused by repetitive micro trauma from the Achilles tendon on the unossified calcaneal apophysis. Sever’s disease is one of the most common causes of heel pain in pre-adolescents and adolescents. This condition typically affects children aged between 8 to 14 years of age, as the calcaneal apophysis ossification centre usually appears at around 7 to 9 years of age, with complete fusion occurring by 15 to 17 years of age.
Patients with Sever’s disease typically present with pain and tenderness in one or both heels following ambulation with no history of direct trauma. Symptoms are usually relieved with rest and cessation of specific activity. Pain is usually reproducible upon palpation of the insertion of the Achilles tendon on the posterior heel - the squeeze test. Patients with chronic and painful Sever’s disease may develop toe walking and a limp in an effort to relieve symptoms.
There are several predisposing factors believed to be associated with Sever’s disease including Achilles tendon tightness, biomechanical abnormalities including an excessively pronated foot, poor footwear, substantial increase in activity, running on hard surfaces and high impact sports such as soccer, rugby and football.