Nweke Tonyclinton C
Podiatric Surgery, Wyckoff Heights Medical Center, New York, USA.
Cureus. 2025 Jul 25;17(7):e88779. doi: 10.7759/cureus.88779. eCollection 2025 Jul.
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.
塞弗氏病（跟骨骨骺炎）是身体活跃的儿童足跟疼痛的常见原因。它是由青春期跟骨生长板受到反复应力所致。本综述通过在PubMed上使用“塞弗氏病”和“跟骨骨骺炎”检索词，综合了17项不同的同行评审研究的证据。共检索到约243篇文章，其中17篇符合纳入标准。目的是评估塞弗氏病保守治疗的疗效。关键干预措施包括使用定制足部矫形器、物理治疗（包括跟腱拉伸和背屈强化）、非甾体抗炎药（NSAIDs）、冷冻疗法、足跟垫、肌内效贴布和体外冲击波疗法（ESWT）。定制足部矫形器改善了生物力学对线，优于现成的足跟垫。物理治疗有助于在两个月内恢复运动。肌内效贴布增强了功能，但在缓解疼痛方面与安慰剂效果相当。足跟垫提供短期益处，ESWT显示出前景但缺乏有力证据。NSAIDs和冷冻疗法对急性症状管理有效。制定了一个分层治疗框架，优先选择定制矫形器和物理治疗（跟腱拉伸和背屈强化）（第1层），其次是足跟垫和肌内效贴布等辅助治疗（第2层）、ESWT等新兴治疗（第3层）以及不推荐的选项如现成的矫形器（第4层）。尽管存在方法学局限性，如样本量小和研究设计异质性，但保守治疗始终能减轻塞弗氏病患者的疼痛并恢复其功能。建议进行一项拟议的多中心随机对照试验，比较定制矫形器、物理治疗和ESWT在12个月内的效果，以标准化结果并明确最佳治疗方案。
