Sever's Disease

Definition

 

Calcaneal apophysitis / Pulling osteochondrosis

 

Epidemiology

 

Young boys

- peak age 10

- bilateral in 60%

 

Aetiology

 

Overuse injury of calcaneal apophysis

Repeated microfracture

 

History

 

Mechanical heel pain

Worse if barefoot

 

Examination

 

No redness or swelling

Tenderness on sides of tendon insertion

Restricted ankle dorsiflexion

 

Xray

 

Controversial whether normal

- increased fragmentation & density of apophysis

- may be the same on the other side

 

Primarily performed to exclude other conditions

- giant cell tumours

- UBC

 

Management

 

Algorithm

 

Restrict activities for 1-3 months

 

NSAIDs

- oral

- topical

 

Physio

- T achilles stretching / dorsiflexion exercises

 

Orthotics

- heel raises

- custom made heel cups & insoles

- short leg cast for 4/52 if symptoms severe