Sever Disease (Calcaneal Apophysitis)

Sever disease, or calcaneal apophysitis, is a common cause of heel pain in children or young athletes aged 8 to 15 with immature skeletons. Sever disease results from repetitive microtrauma to the secondary ossification center by traction of the Achilles tendon insertion on the calcaneus. The condition frequently coincides with triceps surae shortening, which stems from the difference in growth rates between bone and muscle. Sever disease is common among children and adolescents who engage in sports that involve running and jumping. The pain occurs due to a sudden increase in sports activities, especially during a rapid growth spurt. However, the pain subsides with rest or when the activity is stopped. Sever disease may also develop in less active adolescents who wear flat shoes. Patients affected by Sever disease usually report pain resolution during periods of rest or when the growth plate fully closes. Clinical examination demonstrates tenderness over the calcaneal insertion point of the Achilles tendon and a positive squeeze test involving manual medial and lateral compression of the posterior calcaneus. The diagnosis of Sever disease is primarily clinical and does not necessitate imaging studies. However, plain radiographs can assist in ruling out bone fractures, whereas magnetic resonance imaging (MRI) is valuable in differentiating Sever disease from infections and tumors.  Sever disease typically follows a self-limited course, and its management involves activity modification or relative rest in response to pain. Symptom control incorporates the use of anti-inflammatory medications, ice, heel cups or heel lifts, and, in severe instances, immobilization. A rehabilitation regimen emphasizing heel cord stretching and strengthening should be integrated into the care plan to alleviate symptoms and address underlying biomechanical factors that may predispose the individual to the condition.