Sever disease, first described in 1912, is a painful inflammation of the calcaneal apophysis. It is classified with the child and adolescent nonarticular osteochondroses. (The other disease in this
group is Iselin disease, which is inflammation of the base of the fifth metatarsal.) The etiology of pain in Sever disease is believed to be repetitive trauma to the weaker structure of the
apophysis, induced by the pull of the tendo calcaneus (Achilles tendon) on its insertion. This results in a clinical picture of heel pain in a growing active child, which worsens with activity. Sever
disease is a self-limited condition, accordingly, no known complication exists from failure to make the correct diagnosis.
Young athletes typically sustain the injury due to repeated stress caused by running and jumping. Partaking in any high speed sports can thus partly provoke the condition, such as football, rugby,
basketball, hockey or track athletics. Crucially the injury is linked to overuse, so exercising with fatigued leg muscles, without a suitable warm up, or beginning a new strenuous physical activity
are all risk factors. Placing excessive weight or pressure on the heel can also cause the injury. Another factor related to Sever's disease is overpronation, a biomechanical error that makes the foot
roll too far inwards.
The most common symptom of Sever's disease is acute pain felt in the heel when a child engages in physical activity such as walking, jumping or running. Children who are very active athletes are
among the group most susceptible to experiencing Sever's disease because of the extreme stress and tension they place on their growing feet. Improper pronation, the rolling movement of the foot
during walking or running, and obesity are all additional conditions linked to causing Sever's disease.
Most often, a healthcare professional can diagnose Sever?s disease by taking a careful history and administering a few simple tests during the physical exam. A practitioner may squeeze the heel on
either side; when this move produces pain, it may be a sign of Sever?s disease. The practitioner may also ask the child to stand on their tiptoes, because pain that occurs when standing in this
position can also be an indication of Sever?s disease.
Non Surgical Treatment
Rest is best to allow healing .Only do as much exercise as able without causing pain. Many children can continue to play sports but if pain is severe then stopping the activity may be the only way to
allow the pain to settle. The child might be able to do things that do not put pressure on the heel, such as swimming and cycling. Ice and cold therapy may be useful to reduce pain and swelling,
particularly following activity or sport. The area should be iced until it feels cold not ?frozen?. Never apply ice directly onto the skin, as this may cause tissue damage. Medication. The following
will help treat your child?s pain. Paracetamol (see bottle for instructions) Ibuprofen (see bottle for instructions). Exercises, perform foot and leg exercises to stretch and strengthen the leg
muscles & tendons. Increase calf flexibility by doing calf stretches several times per day. Protect the heel, your shoes might need a heel lift or arch support. Select a shoe with good arch
support and heel lift if possible. Take it one step at a time: gradually resume running and impact activities as symptoms allow.