Conservative Management of Sever's Disease (Calcaneal Apophysitis): A Comprehensive Review of Treatment Efficacy.

Sever's disease (calcaneal apophysitis) is a common cause of heel pain in physically active children. It results from repetitive stress on the calcaneal growth plate during adolescence. This literature review synthesizes evidence from 17 different peer-reviewed studies from PubMed using the terms "Sever's disease" and "calcaneal apophysitis." Approximately 243 articles were retrieved, and 17 met the inclusion criteria. The aim is to evaluate the efficacy of conservative treatments for Sever's disease. Key interventions include the use of custom-made foot orthoses, physical therapy (including heel cord stretching and dorsiflexion strengthening), non-steroidal anti-inflammatory drugs (NSAIDs), cryotherapy, heel lifts, kinesio taping, and extracorporeal shockwave therapy (ESWT). Custom foot orthotics improved biomechanical alignment, outperforming off-the-shelf heel lifts. Physical therapy facilitated return to sport within two months. Kinesio taping enhanced function but showed comparable pain relief to placebo. Heel lifts provided short-term benefits, and ESWT showed promise but lacked robust evidence. NSAIDs and cryotherapy were effective for acute symptom management. A tiered treatment framework was developed, prioritizing custom orthoses and physical therapy (heel cord stretching and dorsiflexion strengthening) (Tier 1), followed by adjunctive therapies like heel lifts and kinesio taping (Tier 2), emerging treatments like ESWT (Tier 3), and non-recommended options such as off-the-shelf orthoses (Tier 4). Despite methodological limitations, such as small sample sizes and heterogeneous study designs, conservative treatments consistently alleviated pain and restored function in patients with Sever's disease. A proposed multicenter randomized controlled trial is recommended to compare custom orthoses, physical therapy, and ESWT over 12 months to standardize outcomes and clarify optimal treatment protocols.