Sports Medicine
Sports Injury Prevention & Rehabilitation
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Severs Disease

(Also known as Calcaneal Apophysitis)
What is Severs disease?
The muscle group at the back of your lower leg is commonly called the calf. The calf comprises of two major muscles (gastrocnemius and soleus) both of which insert into the heel bone via the Achilles tendon.
In people who have not reached skeletal maturity, a growth plate exists where the Achilles tendon inserts into the heel bone. This growth plate is primarily comprised of cartilage. Every time the calf contracts, it pulls on the Achilles tendon which in turn pulls on the heels growth plate. When this tension is too forceful or repetitive, irritation to the growth plate may occur resulting in pain and sometimes an increased bony prominence at the back of the heel. This condition is called Severs disease.
Severs disease is typically seen in children or adolescents during periods of rapid growth. This is because muscles and tendons become tighter as bones become longer. As a result, more tension is placed on the heels growth plate.

Signs and symptoms of Severs disease
Patients with Severs disease typically experience pain that develops gradually in the back of the heel or achilles region. In less severe cases, patients may only experience an ache or stiffness in the heel that increases with rest (especially at night or first thing in the morning) following activities requiring strong or repetitive contraction of the calf muscles such as running (especially uphill) or during sports involving running, jumping or hopping. The pain associated with this condition may also warm up with activity in the initial stages of the condition.
As the condition progresses, patients may experience symptoms that increase during activity and affect performance. Pain may also increase on firmly touching the affected region and occasionally a bony lump may be palpable at the back of the heel.

Treatment for Severs disease

Severs disease is a self limiting condition that gradually resolves as the patient moves towards skeletal maturity. This usually takes between 6 to 12 months but may persist for as long as 2 years. Patients with Severs disease typically improve gradually over time and full function is restored. Management primarily comprises of activity modification so the patient is pain-free.
Whether or not a patient should continue playing sport is dependent on symptoms. Patients with mild symptoms may wish to continue to play some or all sport, others may choose to modify their program. Generally it is recommended that patients keep active provided their symptoms are mild or absent.

Contributing factors to the development of Severs disease
There are several factors which may increase the likelihood of developing this condition. These need to be assessed and corrected with direction from a doctor to ensure an optimal outcome. Some of these factors include:
  • inappropriate footwear
  • calf tightness
  • calf weakness
  • joint stiffness
  • poor lower limb biomechanics
  • poor foot posture
  • inappropriate training
Physical therapy for Severs disease
Physical therapy treatment is vital for for patients with this condition to reduce pain, allow for increased activity levels and ensure an optimal outcome. Treatment may comprise:
  • biomechanical correction
  • activity modification advice
  • soft tissue massage
  • education
  • the use of crutches
  • electrotherapy
  • icing
  • taping
  • exercises addressing any flexibility, strength or balance issues
  • gradual return to activity
Other intervention for Severs disease
Occasionally, a consultation with a podiatrist may be indicated to correct abnormal foot biomechanics and improve the condition. The treating doctor can advise if this is required.