According to a study, Sever’s Disease is a relatively common problem that affects mostly children between the ages of 8 and 14-years-old. What is Sever’s Disease and what is Sever’s Disease Physical Therapy? I am glad you asked!

Sever's Disease ( Aka Calcaneal Apophysitis)

What is Sever’s Disease?

Sever’s Disease is also known as Calcaneal Apophysitis. This condition typically affects, as mentioned earlier, children between 8 and 14-years-old because the calcaneus (heel bone), does not fully develop until at least age 14. Until that time, new bone forms at the physis (growth plate), a weak area located at the back of the heel. When there is too much repetitive stress on the growth plate, inflammation can develop.

A Diagram of the foot–conditions/severs-disease/

Sever’s Disease was named after James Warren Sever, the American doctor who first described the condition in 1912. Dr. Sever described it as “ an inflammatory injury to the calcaneal apophysis associated with muscle strain in the immature skeleton.” It is similar to Osgood-Schlatter disease in the knee and “little leaguer’s elbow” in the elbow.

However, Server’s Disease is not a true disease. It is the most common cause of heel pain in children and can occur in one foot or both feet.

Calcaneal Apophysitis is a self-limiting condition. Symptoms often ease with time, without treatment. However, medical professionals can help manage the symptoms of Sever’s Disease so that the child can continue to participate in physical activities.

What Causes Sever’s Disease?

1. Growth spurts

A child’s heel bone grows faster than the muscles, tendons, and ligament in his or her leg during a growth spurt. When the tendons and muscles cannot grow fast enough to keep up, they become stretched too tight and eventually cause pain.

2. Participation in sports activities

A child who is very active, especially if he or she participates in sports that involve a lot of running and jumping on hard surfaces (e.g. soccer, basketball, or gymnastics) can put more strain on typically overstretched tendons.

3. Wearing very flat shoes

Even less active kids can suffer from Sever’s disease if they wear very flat shoes. This type of shoes offers little protection for the feet which means the wearer of the shoes also puts a strain on the tendon just by constantly walking or running on hard surfaces.

4. Other factors

a. Obesity: A child’s extra weight can put pressure on his or her knees, legs, and feet. It follows that even his/her heels will become affected by the extra load.

b. A tight Achilles tendon

c. A flatfoot or a high-arched foot

What it looks like to be "Flat Footed"

What are the symptoms of calcaneal apophysitis?

  1. Heel pain
  2. Mild swelling at the heel
  3. Tenderness under the heel that worsens if the heel or foot is squeezed
  4. Redness of the skin
  5. Stiffness of the foot upon walking
  6. Difficulty walking

Diagnosis of Sever’s Disease

Doctors diagnose Sever’s Disease or calcaneal apophysitis based on a child’s medical history and symptoms he or she may have.

The doctor may also perform a “squeeze test” on the child’s heel. The doctor squeezes the back of the child’s heel to check if it hurts.

Imaging tests such as X-rays are used to rule out other injuries such as fractures and to evaluate the condition of the heel.

How is Sever’s Disease treated?

1. Reduce activities

All activities that cause pain should either be stopped or reduced.

2. The heel should be supported

Use custom orthotic devices or temporary shoe inserts that can provide needed support for the heel.

3. Medications

The doctor may provide nonsteroidal anti-inflammatory drugs (NSAIDs) to help reduce the pain and inflammation.

4. Immobilization

In severe cases, the doctor may put a cast on the injured area to promote healing while keeping the affected foot and ankle totally immobile.

5. Server’s Disease Physical Therapy

The treatment depends on the severity of the child’s symptoms. It may be used alone or in combination with other treatment options. This may include:

a. Exercises for server’s disease such as stretching

b. Ultrasound, NSAIDs

c. Taping

d. Advise the patient to wear supportive shoes or shoe orthoses

e. Advise patient to reduce participation in sports

f. Crutches may be used in severe cases or if the pain is in both heels (bilateral)

The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injury by using a variety of methods that include exercises, stretches, traction, electrical stimulation, and massage.

Note: Often, heel pain in children will return after it has been treated. The reason for this is the heel bone of a child is still growing. Recurring heel pain may be a sign of sever’s disease or may be an indication of a different problem. If heel pain recurs after treatment, make sure to consult your foot and ankle doctor.

How can Sever’s Disease be prevented?

  1. Good joint and muscle flexibility should be maintained in the years leading up to growth spurt. Typically, 8 to 10 for girls, and 10 to 12 for boys.
  2. Foot arch problems such as flat feet should be addressed after age five if they do not appear to be self-correcting.
  3. Patients are advised to wear supportive, shock-absorbing shoes.
  4. Avoid a lot of running and pounding on hard surfaces.
  5. If participating in sports, avoid over-training and take plenty of rest, especially if the child begins to feel pain in her heel.
  6. If overweight, help the child to lose the extra pounds. This will help greatly in reducing the pressure on his or her heels.

At Vigor Physical Therapy & Rehabilitation we provide Server’s Disease Physical Therapy.

Dr. Igor Voloshin, DPT, our founder, and director, specializes in sports physical therapy, athletic training for injury prevention, and sports performance training for all ages and ability levels.

Dr. Voloshin has served on the staff of world-renowned rehabilitation clinics including Hospital for Special Surgery in New York, Kessler Institute for Rehabilitation and the Visiting Nurse Association of New Jersey.

With his extensive experience and skills, you are assured that you will receive highly personalized and specialized care at our facility.

If you would like to visit us or speak to Dr. Voloshin, contact us today.