EMed

Sever's disease (calcaneal apophysitis)

Background

  • Heel pain - calcaneal apophysitis - similar to Osgood Schlatter
  • Mostly very early teens or before
  • Repeated "pull off" micro-trauma at insertion tendo-achilles
  • M:F = 2:1
  • May be bilateral

Clinical

  • Clinical Dx
  • Heel pain worse with / after activity (particularly jumping)
  • Exam - pain triggered by active toe raises
  • Tenderness (deep palpation) at tendo-achilles insertion
  • Pain on forced dorsiflexion ankle

Differential Dx

  • Calcaneal fracture (different mechanism, tender laterally over calcanium)
  • Achilles tendonopathy
  • # Achilles tendon
  • Osteomyelitis (beware nocturnal/constitutional symptoms)
  • Tarsal coalation (congenital fusion mid foot bones - may require CT)

Investigations

  • Plain x-ray only if persisting or constitutional symptoms

Management

  • Reduce triggering activity (particularly jumping sports)
  • In-shoe heel lift
  • Achilles stretching exercises
  • Post exercise local ice
  • Very rarely and equinus cast may be required

Content by Dr Íomhar O' Sullivan 17/09/2012. Last review Dr ÍOS 8/08/23.