Sever condition is an inflammation of the growth plate of the bone at the back of the heel (apophysitis of the calcaneus). The inflammation of Sever condition is at the point where the Achilles
tendon attaches to the back of the heel bone.
There are several factors which may increase the likelihood of developing this condition. These need to be assessed and corrected with direction from a physiotherapist to ensure an optimal outcome.
Some of these factors include inappropriate footwear, calf tightness and/or weakness, joint stiffness (particularly the foot and ankle), poor lower limb biomechanics, inappropriate or excessive
training, inadequate recovery periods from training or activity, inappropriate training surfaces, inadequate warm up, poor core stability, a lack of lower limb strength and stability, poor
proprioception or balance, rapid growth and age.
This syndrome can occur unilaterally or bilaterally. The incidence of bilaterally is approximately 60%. Common signs and symptoms include posterior inferior heel pain (over the medial and lateral
surface of the bone). Pain is usually absent when the child gets up in the morning. Increased pain with weight bearing, running or jumping (= activity-related pain). The area often feels stiff. The
child may limp at the end of physical activity. Tenderness at the insertion of the tendons (= an avascular necrosis of the arthropathy). Limited ankle dorsiflexion range secondary to tightness of the
Achilles tendon. Hard surfaces and poor-quality or worn-out athletic shoes contribute to increased symptoms. The pain gradually resolves with rest. Reliability or validity of methods used to obtain
the ankle joint dorsiflexion or biomechanical malalignment data are not commented upon, thus reducing the quality of the data. Although pain and limping are mentioned as symptomatic traits, there
have been no attempts to quantify the pain or its effect on the individual.
All medical diagnosis should be made by taking a full history, examining the patient then performing investigations. The problem usually occurs in boys who are going through or have just gone through
a growth spurt; one or both heels may be affected. Initially the pain may be intermittent occurring only during or after exercise. As the problem gets worse, pain may be present most of the time.
There may be swelling over the back of the heel and this area is painful if touched or knocked. On examination the patient often has flat feet, very tight legs muscles especially the
Non Surgical Treatment
A physiotherapist will assess your pain, presentation and biomechanics. They can then treat your sever?s disease with hands on techniques which may include massage, manual therapy and taping. Your
physiotherapist can then provide advice on what you can do at home to further progress your treatment, this may include stretching, strengthening and activity modification. In some cases orthotic
prescription may be of benefit.
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel.
Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and
inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a
cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence
of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle