An update on Calcaneal Apophysitis (Sever’s disease)

Often children between the ages of eight and thirteen attend the podiatry clinic with heel pain. One differential diagnosis is calcaneal apophysitis or otherwise known as sever’s disease. Calcaneal apophysitis is the inflammation of a calcaneal growth plate causing pain in the heel posteriorly, it is classified as a non-articular Osteochondrosis at an impact site (O’Gradaigh & Crisp, 2012).

The calcaneus in a child under sixteen years contains a growth plate posteriorly. This is the section where the Achilles tendon inserts on the calcaneus. Around sixteen years of age, the growth plate ossifies onto the calcaneum. Sever’s disease is the disturbance or micro trauma in this growth area.

Calcaneal apophysitis is more common in individuals who participate in active sport. It is a traction apophysitis of the Achilles tendon insertion at the calcaneus and is one of the most common causes of heel pain in children (Micheli & Ireland, 1987). The condition can occur in both sexes and usually resolves once bone growth has ceased. Children are usually in an active growth spurt during which time the Calcaneal apophysitis (Ogden et al, 2004) causes pain. It is thought that the long bones growth exceeds the musculature growth (posterior muscle compartment), causing pulling on the calcaneal muscle attachment. However Michelli & Ireland (1987) suggest the exact aetiology is undetermined and that it is thought to be a repetitive overuse micro trauma to the calcaneus.

Patients complain of pain at the posterior calcaneus during exercise, especially when running or jumping (as it increases the symptoms), discomfort in the morning and a limping gait. The calcaneal apophysis is tender to palpate and is usually most painful upon heel strike (Goel & Watt, 2002). Other symptoms include pain on palpation or