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{{Infobox medical condition (new)
{{Infobox medical condition (new)
| name = Sever's disease
| name = Sever's disease (Calcaneal apophysitis)
| synonyms = Apophysitis of the Calcaneus
| synonyms = Calcaneus apophysitis, Severs
| image = Sclerosis and fragmentation of the calcaneal apophysis.jpg
| image = Sclerosis and fragmentation of the calcaneal apophysis.jpg
|alt=| caption = [[X-ray]] of the foot of an 11-year-old child,showing sclerosis and fragmentation of the [[calcaneal apophysis]]. This is a sign of low [[sensitivity and specificity]] of Sever's disease, because those with Sever's disease may not have it, and it is commonly present in feet without any symptoms.<ref>{{cite web|url=http://emedicine.medscape.com/article/1237477-workup|title=Calcaneal Apophysitis (Sever Disease) Workup|website=[[Medscape]]|author=Mark A Noffsinger|date=2016-09-07|access-date=2017-01-19}}</ref>
|alt=| caption = [[X-ray]] of the foot of an 11-year-old child,showing sclerosis and fragmentation of the [[calcaneal apophysis]]. This is a sign of low [[sensitivity and specificity]] of Sever's disease, because those with Sever's disease may not have it, and it is commonly present in feet without any symptoms.<ref>{{cite web|url=http://emedicine.medscape.com/article/1237477-workup|title=Calcaneal Apophysitis (Sever Disease) Workup|website=[[Medscape]]|author=Mark A Noffsinger|date=2016-09-07|access-date=2017-01-19}}</ref>
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}}
}}


'''Sever's Disease''', otherwise known as [[apophysitis]] of the [[calcaneus]], is an inflammation of the [[growth plate]] in the heel of growing children. The condition presents as pain in the heel and is caused by repetitive stress to the heel and is thus particularly common in active children. It usually resolves when the bone has completed growth or activity is lessened. The pain can be eased through stretching.
'''[[Calcaneus]] [[apophysitis]]''', used to be called Sever's Disease and is an inflammation at the back of the heel (or calcaneus) [[growth plate]] in growing children. The condition is thought to be caused by repetitive stress at the heel. This condition is benign and common and usually resolves when the growth plate has closed or during periods of less activity. It occurs in both males and females. There are a number of locations in the body that may get apophysitis pain. Another common one is at the front of the knee which is known as apophysitis of the tibial tuberosity or Osgood Schlatter's disease.


==Symptoms==
==Symptoms==
Children's with calcaneal apophysitis commonly complain of pain at the back of the heel. This pain increases with jumping and some running sports.
The most prominent symptom of Sever's disease is heel pain which is usually aggravated by physical activity such as walking, running or jumping.
The pain is localised to the posterior and plantar side of the heel over the calcaneal apophysis. Sometimes, the pain may be so severe that it may cause limping and interfere with physical performance in sports. External appearance of the heel is almost always normal, and signs of local disease such as edema, erythema (redness) are absent. The main diagnostic tool is pain on medial-lateral compression of the calcaneus in the area of growth plate, the so-called “squeeze test.” Foot radiographs are usually normal. Therefore, the diagnosis of Sever's disease is primarily clinical.<ref>{{cite journal|last=Kose|first=Ozkan|title=Do we really need radiographic assessment for the diagnosis of non-specific heel pain (calcaneal apophysitis) in children?|journal=Skeletal Radiology|year=2010|volume=39|issue=4|pages=359–361|doi=10.1007/s00256-009-0774-y|pmid=19672591|s2cid=19889365}}</ref>
Sometimes, the pain makes children limp and may result in poor sports performance or them not wanting to participate in some sports. The back of the heel is never swollen or red, unless there has been shoe rubbing. When the back of the heel is squeezed from the inside and outside, children with calcaneal apophysitis will report pain. Foot radiographs are not needed to diagnose calcaneal apophysitis as the growth plate can look similar with or without pain. Health professionals should only refer for imaging when the symptoms don't match with the usual presentation or there has been an injury that has resulted in heel pain. Therefore, the diagnosis of Sever's disease is primarily from history and physical assessment.<ref>{{cite journal|last=Kose|first=Ozkan|title=Do we really need radiographic assessment for the diagnosis of non-specific heel pain (calcaneal apophysitis) in children?|journal=Skeletal Radiology|year=2010|volume=39|issue=4|pages=359–361|doi=10.1007/s00256-009-0774-y|pmid=19672591|s2cid=19889365}}</ref>


==Cause==
==Cause==
Sever's disease is directly related to overuse of the [[bone]] and tendons in the heel. This can come from playing [[sports]] or anything that involves a lot of heel movement. It can be associated with starting a new sport, or the start of a new season. Children who are going through adolescence are also at risk of getting it because the heel bone grows quicker than the leg.<ref>{{cite web|url=http://kidshealth.org/parent/medical/bones/severs_disease.html |title=Sever's Disease |publisher=Kidshealth.org |access-date=2014-04-29}}</ref><ref name="pmid15555843">{{cite journal |author=Hendrix CL |title=Calcaneal apophysitis (Sever disease) |journal=Clinics in Podiatric Medicine and Surgery |volume=22 |issue=1 |pages=55–62, vi |year=2005 |pmid=15555843 |doi=10.1016/j.cpm.2004.08.011}}</ref> Bearing too much [[weight]] on the heel can also cause it, as can excessive traction since the bones and tendons are still developing. It occurs more commonly in children who over-pronate, and involves both heels in more than half of patients. It is the equivalent of Osgood Schlatter disease of the knee.
There are no known causes of calcaneal apophysitis or any ways that it can be prevented. Instead there are things that may contribute to calcaneal apophysitis developing. Children who complain of this type of heel pain commonly are taller (may have just had a growth spurt) or heavier. They also often play [[sports]] that have higher jumping, running or direction changes like basketball or soccer. It can also occur more in children who play on hard surfaces. Sometimes children who also start a new sport also complain on this pain or it may happen at the start of a new season. Because calcaneal apophysitis also occurs around puberty, it is thought that it is related to rapid growth and perhaps muscle tightness,<ref>{{cite web|url=http://kidshealth.org/parent/medical/bones/severs_disease.html |title=Sever's Disease |publisher=Kidshealth.org |access-date=2014-04-29}}</ref> <ref name="pmid15555843">{{cite journal |author=Hendrix CL |title=Calcaneal apophysitis (Sever disease) |journal=Clinics in Podiatric Medicine and Surgery |volume=22 |issue=1 |pages=55–62, vi |year=2005 |pmid=15555843 |doi=10.1016/j.cpm.2004.08.011}}</ref> but this is not the case for all children <<ref name="pmid 26001316">{{cite journal |author=James AM, Williams CM, Luscombe M, Hunter R, Haines, T |title=Factors Associated with Pain Severity in Children with Calcaneal Apophysitis (Sever Disease) |journal=The Journal of Pediatrics |volume=167 |issue=2 |pages=455-459 |year=2015 |pmid=26001316 |doi.org/10.1016/j.jpeds.2015.04.053}}</ref>. There have been reports that is may also be associated with foot posture (high arches or flat feet). But in large studies, children with calcaneal apophysitis had similar foot postures to children without pain. This means, while some children have high arches or flat feet, not all will get calcaneal apophysitis.

==Prevention==
*Maintain good flexibility through stretching exercises
*Avoid excessive running on hard surfaces
*Use quality, well-fitting [[shoes]] with firm support and a shock-absorbent [[Sole (shoe)|sole]]


==Treatment==
==Treatment==
Parents can often use home treatments to resolve pain. Health professionals who also commonly treat this condition are podiatrists, physiotherapists, family medical doctors, paediatricians or orthopaedic surgeons.
Treatment may consist of one or more of the following:
Treatment may consist of one or more of the following:
*Using ice on the area or an over the counter anti-inflammatory from the pharmacy (not aspirin).
*Elevating the heel
*Load management including some sport substitution or lessening the amount, not playing for as long or having more frequent breaks.
*Stretching hamstring and calf muscles 2–3 times daily
*Using [[RICE (medicine)|R.I.C.E.]] (Rest, Ice, Compression, Elevation)<ref name="pmid8900359">{{cite journal |vauthors=Madden CC, Mellion MB |title=Sever's disease and other causes of heel pain in adolescents |journal=American Family Physician |volume=54 |issue=6 |pages=1995–2000 |year=1996 |pmid=8900359 }}</ref>
*Heel raisers or heel cushions <ref name="pmid26917682">{{cite journal |author=James A, Williams C, Haines T |title=Effectiveness of footwear and foot orthoses for calcaneal apophysitis: a 12-month factorial randomised trial|journal=Br J Sports Med, |volume=50 |issue=20 |pages=1268-1275, |year=2016 |pmid=15555843 |doi=10.1136/bjsports-2015-094986}}</ref>
*Foot orthotics <ref name="pmid26917682">{{cite journal |author=James A, Williams C, Haines T |title=Effectiveness of footwear and foot orthoses for calcaneal apophysitis: a 12-month factorial randomised trial|journal=Br J Sports Med, |volume=50 |issue=20 |pages=1268-1275, |year=2016 |pmid=15555843 |doi=10.1136/bjsports-2015-094986}}</ref>
*Foot orthotics
*If pain is present in some footwear more than others, consider changing footwear to increase support or cushioning
*Medication
*Avoid being barefoot for long period of times while painful
*Physical therapy
*If doing a sport in barefoot, a heel cushion or taping may assist during the activity
*Icing daily (morning)

*Heating therapy
*Avoiding high-heeled shoes


==Recovery==
==Recovery==
Sever's disease is not a serious condition and many children get better without needing health professional care. If use of home treatments like putting ice on the heels or changing sport don't work, children should be assessed by a health professionals to personalise the treatment and make sure it is really is calcaneal apophysitis. This condition does not have any long term foot or ankle problems.
Sever's disease is self-recovering, meaning that it will go away on its own when the foot is used less or when the bone is through growing. The condition is not expected to create any long-term disability, and expected to subside in 2 or more weeks.<ref name="pmid8900359"/> Some orthopedic surgeons will put the affected foot in a cast to immobilize it.


While pain from calcaneal apophysitis can go away quickly, it often comes back from time to time. It can appear until children are 12-15 years old.
While symptoms can resolve quickly, they can recur. Sever's disease is more common in boys than girls; the average age of symptom onset is nine to eleven years.


==Eponym==
==Eponym==
It is named for James Warren Sever (1878–1964), an American orthopedic doctor, who described it in 1912.<ref>{{cite web|url=http://medical-dictionary.thefreedictionary.com/Sever+disease |title=Sever disease - definition of Sever disease in the medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia |publisher=Medical-dictionary.thefreedictionary.com |access-date=2014-04-29}}</ref> Sever had "The Principles of Orthopaedic Surgery" published in 1940 through the Macmillan Company.
The correct term for this condition is calcaneal apophysitis. The term Sever's Disease was coined after it was first described by James Warren Sever (1878–1964), an American orthopedic doctor, in 1912.<ref>{{cite web|url=http://medical-dictionary.thefreedictionary.com/Sever+disease |title=Sever disease - definition of Sever disease in the medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia |publisher=Medical-dictionary.thefreedictionary.com |access-date=2014-04-29}}</ref> Sever had "The Principles of Orthopaedic Surgery" published in 1940 through the Macmillan Company. Dr Sever described it as an apophyseal injury and given it is neither contagious or progressive, the disease label is being used less with time.


==See also==
==See also==
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===Further reading===
===Further reading===
*{{cite journal |vauthors=James A, Williams CM, Haines T|title=Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever's disease): a systematic review |journal=J Foot Ankle Res |volume=6 |issue=1 |pages=34–8 |year=2013 |pmid= 23641779 |doi=10.1186/1757-1146-6-16}}
*{{cite journal |vauthors=Micheli LJ, Ireland ML |title=Prevention and management of calcaneal apophysitis in children: an overuse syndrome |journal=J Pediatr Orthop |volume=7 |issue=1 |pages=34–8 |year=1987 |pmid=3793908 |doi=10.1097/01241398-198701000-00007|s2cid=762007 }}
*{{cite journal |vauthors=Micheli LJ, Ireland ML |title=Prevention and management of calcaneal apophysitis in children: an overuse syndrome |journal=J Pediatr Orthop |volume=7 |issue=1 |pages=34–8 |year=1987 |pmid=3793908 |doi=10.1097/01241398-198701000-00007|s2cid=762007 }}
* {{cite journal|last=Bailey|first=Christopher|author2=Cannon, Mary |title=Sever Disease (Calcaneal Apophysitis)|journal=The Journal of the American Osteopathic Association|date=May 2014|volume=114|issue=5|pages=411|doi=10.7556/jaoa.2014.081|pmid=24778005|doi-access=free}}
* {{cite journal|last=Bailey|first=Christopher|author2=Cannon, Mary |title=Sever Disease (Calcaneal Apophysitis)|journal=The Journal of the American Osteopathic Association|date=May 2014|volume=114|issue=5|pages=411|doi=10.7556/jaoa.2014.081|pmid=24778005|doi-access=free}}

Revision as of 08:00, 20 November 2021

Sever's disease (Calcaneal apophysitis)
Other namesCalcaneus apophysitis, Severs
X-ray of the foot of an 11-year-old child,showing sclerosis and fragmentation of the calcaneal apophysis. This is a sign of low sensitivity and specificity of Sever's disease, because those with Sever's disease may not have it, and it is commonly present in feet without any symptoms.[1]
SpecialtyRheumatology Edit this on Wikidata
SymptomsPain in the heel
Diagnostic methodclinical, imaging (xray)

Calcaneus apophysitis, used to be called Sever's Disease and is an inflammation at the back of the heel (or calcaneus) growth plate in growing children. The condition is thought to be caused by repetitive stress at the heel. This condition is benign and common and usually resolves when the growth plate has closed or during periods of less activity. It occurs in both males and females. There are a number of locations in the body that may get apophysitis pain. Another common one is at the front of the knee which is known as apophysitis of the tibial tuberosity or Osgood Schlatter's disease.

Symptoms

Children's with calcaneal apophysitis commonly complain of pain at the back of the heel. This pain increases with jumping and some running sports. Sometimes, the pain makes children limp and may result in poor sports performance or them not wanting to participate in some sports. The back of the heel is never swollen or red, unless there has been shoe rubbing. When the back of the heel is squeezed from the inside and outside, children with calcaneal apophysitis will report pain. Foot radiographs are not needed to diagnose calcaneal apophysitis as the growth plate can look similar with or without pain. Health professionals should only refer for imaging when the symptoms don't match with the usual presentation or there has been an injury that has resulted in heel pain. Therefore, the diagnosis of Sever's disease is primarily from history and physical assessment.[2]

Cause

There are no known causes of calcaneal apophysitis or any ways that it can be prevented. Instead there are things that may contribute to calcaneal apophysitis developing. Children who complain of this type of heel pain commonly are taller (may have just had a growth spurt) or heavier. They also often play sports that have higher jumping, running or direction changes like basketball or soccer. It can also occur more in children who play on hard surfaces. Sometimes children who also start a new sport also complain on this pain or it may happen at the start of a new season. Because calcaneal apophysitis also occurs around puberty, it is thought that it is related to rapid growth and perhaps muscle tightness,[3] [4] but this is not the case for all children <[5]. There have been reports that is may also be associated with foot posture (high arches or flat feet). But in large studies, children with calcaneal apophysitis had similar foot postures to children without pain. This means, while some children have high arches or flat feet, not all will get calcaneal apophysitis.

Treatment

Parents can often use home treatments to resolve pain. Health professionals who also commonly treat this condition are podiatrists, physiotherapists, family medical doctors, paediatricians or orthopaedic surgeons. Treatment may consist of one or more of the following:

  • Using ice on the area or an over the counter anti-inflammatory from the pharmacy (not aspirin).
  • Load management including some sport substitution or lessening the amount, not playing for as long or having more frequent breaks.
  • Heel raisers or heel cushions [6]
  • Foot orthotics [6]
  • If pain is present in some footwear more than others, consider changing footwear to increase support or cushioning
  • Avoid being barefoot for long period of times while painful
  • If doing a sport in barefoot, a heel cushion or taping may assist during the activity


Recovery

Sever's disease is not a serious condition and many children get better without needing health professional care. If use of home treatments like putting ice on the heels or changing sport don't work, children should be assessed by a health professionals to personalise the treatment and make sure it is really is calcaneal apophysitis. This condition does not have any long term foot or ankle problems.

While pain from calcaneal apophysitis can go away quickly, it often comes back from time to time. It can appear until children are 12-15 years old.

Eponym

The correct term for this condition is calcaneal apophysitis. The term Sever's Disease was coined after it was first described by James Warren Sever (1878–1964), an American orthopedic doctor, in 1912.[7] Sever had "The Principles of Orthopaedic Surgery" published in 1940 through the Macmillan Company. Dr Sever described it as an apophyseal injury and given it is neither contagious or progressive, the disease label is being used less with time.

See also

References

  1. ^ Mark A Noffsinger (2016-09-07). "Calcaneal Apophysitis (Sever Disease) Workup". Medscape. Retrieved 2017-01-19.
  2. ^ Kose, Ozkan (2010). "Do we really need radiographic assessment for the diagnosis of non-specific heel pain (calcaneal apophysitis) in children?". Skeletal Radiology. 39 (4): 359–361. doi:10.1007/s00256-009-0774-y. PMID 19672591. S2CID 19889365.
  3. ^ "Sever's Disease". Kidshealth.org. Retrieved 2014-04-29.
  4. ^ Hendrix CL (2005). "Calcaneal apophysitis (Sever disease)". Clinics in Podiatric Medicine and Surgery. 22 (1): 55–62, vi. doi:10.1016/j.cpm.2004.08.011. PMID 15555843.
  5. ^ James AM, Williams CM, Luscombe M, Hunter R, Haines, T (2015). "Factors Associated with Pain Severity in Children with Calcaneal Apophysitis (Sever Disease)". The Journal of Pediatrics. 167 (2): 455–459. PMID 26001316. {{cite journal}}: Text "doi.org/10.1016/j.jpeds.2015.04.053" ignored (help)CS1 maint: multiple names: authors list (link)
  6. ^ a b James A, Williams C, Haines T (2016). "Effectiveness of footwear and foot orthoses for calcaneal apophysitis: a 12-month factorial randomised trial". Br J Sports Med,. 50 (20): 1268–1275, . doi:10.1136/bjsports-2015-094986. PMID 15555843.{{cite journal}}: CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link)
  7. ^ "Sever disease - definition of Sever disease in the medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia". Medical-dictionary.thefreedictionary.com. Retrieved 2014-04-29.

Further reading

External links


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