“Severs Disease” – Manifestations and Management
Journal of Clinical Orthopaedics | Vol 7 | Issue 2 | Jul-Dec 2022 | page: 18-21 | Khyati Gupta , Avi Shah 
Author: Khyati Gupta , Avi Shah 
 Fellow in Paediatric Orthopaedics, NH SRCC Children’s Hospital, Mumbai, Maharashtra, India.
 Consultant Paediatric Orthopaedics, NH SRCC Children’s Hospital, Mumbai, Maharashtra, India..
Address of Correspondence
Dr. Avi Shah,
Consultant Paediatric Orthopaedics, NH SRCC Children’s Hospital, Mumbai, Maharashtra, India.
Calcaneal apophysitis (Sever’s Disease) is a common cause of heel pain in growing children. It’s true incidence and etiology in unknown but, recent evidence supports overuse injury as an underlying etiology. It can present as either unilateral or bilateral heel pain in active growing children or adolescents who had a history of new-onset sports activity. Diagnosis mainly relies on a thorough clinical examination with a positive squeeze test being confirmatory. Radiologic imaging may be unnecessary but can help rule out or avoid missing other problematic conditions. Treatment options are mainly conservative and include rest, medications, therapy, or orthosis. Educating parents and coaches is pivotal for the prevention of these self-limiting conditions in young athletes. Evidence suggests a return to sports in most in a few weeks to months after appropriate care.
Keywords: Sever disease, heel pain, calcaneal apophysitis, overuse injury
- Fares MY, Salhab HA, Khachfe HH, Fares J, Haidar R, Musharrafieh U. Sever’s disease of the pediatric population: Clinical, pathologic, and therapeutic considerations. Clin Med Res 2021;19:132-7.
- Howard R. Diagnosing and treating sever’s disease in children. Emerg Nurse 2014;22:28-30.
- Sever JW. Apophysis of oscalcis. NY State J Med 1912;95:1025.
- Wiegerinck JI, Yntema C, Brouwer HJ, Struijs PA. Incidence of calcaneal apophysitis in the general population. Eur J Pediatr 2014;173:677-9.
- Ramponi DR, Baker C. Sever’s disease (Calcaneal apophysitis). Adv Emerg Nurs J 2019;41:10-4.
- Hosny GA, Al-Ashhab MI, Moeselhy MA, Abdrabboh MM. Current concept review of Sever’s disease in paediatric age group. Benha J Appl Sci 2021;6:297-303.
- Rodríguez-Sanz D, Becerro-de-Bengoa-Vallejo R, López-López D, Calvo-Lobo C, Martínez-Jiménez EM, Perez-Boal E, et al. Slowvelocity of the center of pressure and high heel pressures may increase the risk of Sever’s disease: Acasecontrol study. BMC Pediatr 2018;18:357.
- Kose O, Celiktas M, Yigit S, Kisin B. Can we make a diagnosis with radiographic examination alone in calcaneal apophysitis (Sever’s disease)? J Pediatr Orthop B 2010;19:396-8.
- James AM, Williams CM, Haines TP. Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever’s disease): A systematic review. J Foot Ankle Res 2013;6:16.
- White RL. Ketoprofen gel as an adjunct to physical therapist management of a child with Sever disease. Phys Ther 2006;86:424-33.
- McHugh MP, Cosgrave CH. To stretch or not to stretch: The role of stretching in injury prevention and performance. Scand J Med Sci Sports 2010;20:169-81.
- Kase K, Walllis J, Kase T. Clinical Therapeutic Applications of the Kinesio Taping Method. Albuquerque, NM: Kinesio; 2003.
- Hunt GC, Stowell T, Alnwick GM, Evans S. Arch taping as a symptomatic treatment in patients with Sever’s disease: A multiple case series. Foot 2007;17:178-83.
- Kuyucu E, Gülenç B, Biçer H, Erdil M. Assessment of the kinesiotherapy’s efficacy in male athletes with calcaneal apophysitis. J Orthop Surg Res 2017;12:146.
- Perhamre S, Janson S, Norlin R, Klässbo M. Sever’s injury: Treatment with insoles provides effective pain relief. Scand J Med Sci Sports 2011;21:819-23.
- Wiegerinck JI, Zwiers R, Sierevelt IN, van Weert HC, van Dijk CN, Struijs PA. Treatment of calcaneal apophysitis:
Wait and see versus orthotic device versus physical therapy: A pragmatic therapeutic randomized clinical trial. J
Pediatr Orthop 2016;36:152-7.
- Alfaro-Santafé J, Gómez-Bernal A, Lanuza-Cerzócimo C, Alfaro-Santafé JV, Pérez-Morcillo A, Almenar-Arasanz AJ. Effectiveness of custom-made foot orthosesvs. heel-lifts in children with calcaneal apophysitis (Sever’s disease): A CONSORT-compliant randomized trial. Children (Basel).2021;8:963.
- Belikan P, Färber LC, Abel F, Nowak TE, Drees P, Mattyasovszky SG. Incidence of calcaneal apophysitis (Sever’s disease) and return-to-play in adolescent athletes of a German youth soccer academy: A retrospective study of 10 years. J Orthop Surg Res 2022;17:83.
|How to Cite this article: Gupta K, Shah A. “Severs Disease” – Manifestations and Management. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):18-21.|
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