What is it?
Sever('s) disease is a common overuse injury that affects the heel of active children and young teenagers. Pain may occur due to inflammation and stress where the Achilles tendon inserts onto a growth plate located in the heel bone. Activities such as running and jumping cause increased stress on the heel bone’s growth plate. Sever disease is most commonly seen in young athletes who participate in soccer, gymnastics, basketball, tennis, baseball, and football.

Causes
This condition is caused by repetitive stress to the heel bone growth center. It is more common when athletes run and jump constantly, not allowing time for the area to heal.

Risk Factors
• Ages 7 to 14 • Repetitive jumping and running • Periods of rapid growth • Tight calf muscles • Athletic cleats, which generally lack a cushion, arch support, or heel lift that can protect the heel growth plate

Symptoms
• A typical complaint is heel pain that develops slowly and occurs with activity. • The pain usually goes away with rest. • The pain may be in one or both heels. • Heel pain that is worse with running and jumping activities, and that may result In limping. • Children may walk or run with a limp, or they may walk on their toes to avoid pressure on her heels.

Sports Medicine Evaluation & Treatment
A sports medicine physician may diagnose this by history, physical examination, and, at times, x-rays of the heel bones. The athlete will also be evaluated for flexibility, balance, appropriate shoe wear, and appropriate duration and level of activity. • The mainstay of treatment for Sever disease is rest, followed by controlling the pain and irritation at the heel bone growth plate. • Limiting the amount of running and jumping to avoid repetitive stress on the heel bone growth plate, ice, and nonsteroidal anti-inflammatory medications (NSAIDs) can help control the symptoms. • In more severe cases, a period of absolute rest and/or immobilization of the ankle may help with the pain. • Heel lifts and heel gel cups may also help with reducing the pressure on the heel growth plate. • Stretching of the calf muscles may help.

Prevention
• Early recognition of symptoms by the young athlete, coaches, and parents can potentially prevent severe cases. • Once symptoms have been recognized, early activity modification so that the young athlete does not push through the pain may help shorten the duration of symptoms. • Routine stretching of the calf muscles may help prevent this condition. • There should be minimal pain with squatting and jumping, and then, a progression through sports-specific movements, prior to full return to sport. If an athlete experiences pain or begins limping during this sequence, he/she should continue his/her treatment and attempt a return to sports after discussing the symptoms with a sports medicine physician.

AMSSM Member Authors
Mark Riederer, MD Edited by Neeru Jayanthi, MD

References
Anderson SJ and Harris S, eds. Care of the Young Athlete, 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2010.