Severs disease is an adolescent growth plate injury caused by overload in young athletes. It occurs where the Achilles tendon pulls on the growth plate (physis) of the heel bone (calcaneus) which has yet to fuse (ossify). It normally effects children up to the age of 17 while they’re still growing. The bones grow faster than the tendons can keep up and children can experience traction from the tendon upon its insertion on the bone.
How does it present?
- Heel pain localised to the rear of the heel where the Achilles inserts into the bone.
- It can be in one or both heels.
- Running and jumping aggravate pain.
- Not normally painful in the morning.
- Ankle may have limited dorsiflexion.
- Pain eases with rest.
- Tenderness when heel palpated.
- Standing on tip toe will aggravate pain.
What aggravates it?
Sports activity, specifically during a growth spurt and at the beginning of a sports season (i.e., athletics, basketball, football, and rugby) and causes repetitive microtrauma to the area. Having tight claves and Achilles can also increase traction on the heel bone as well as limit ankle mobility.
Management
The injury will settle and not persist once growth is complete, but it is necessary to manage the sporting load that young athlete is performing, particularly if they are experiencing a growth spurt. It is recommended to monitor their height on a fortnightly basis. If symptoms persist then it may be necessary to temporarily stop the offending sport and temporarily change to non-weight bearing sport i.e., cycling and swimming. Gel heel cups may help reduce pain. Lack of ankle mobility and stiffness in the calf and Achilles needs to be addressed.
What else could it be?
- Achilles’ tendinopathy
- Heel spurs
- Plantar fasciitis
- Heel pad syndrome
- Stress fracture of the calcaneus
- Retro calcaneal bursitis