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Sever’s disease is an overuse injury that sometimes occurs in young athletes. It’s not actually a disease, but the term is widely used anyway.

Overuse injuries are the result of repetitive stress, usually at a vulnerable joint. They’re often associated with movements that are high stress and repetitive, such as running and jumping.

In contrast to an acute injury, which is the result of a sudden trauma like a broken bone or ankle sprain, overuse injuries develop over time and often gradually. Eventually, the pain increases to a point that it affects an athlete’s ability to continue in their sport.

Overuse injuries are also called chronic injuries or repetitive stress injuries.

Sever’s disease, or calcaneal apophysitis, presents as heel pain and is caused by an inflammation of the connection between the heel cord (Achilles tendon) and the calcaneus, the large bone that comprises the heel.

This condition happens most often in young athletes, usually between 8 and 15 years old. It tends to be influenced by stress on the body during a growth spurt.

The Achilles tendon is the strongest tendon in the human body. It connects three calf muscles (gastrocnemius, soleus, and plantaris) to the heel of the foot, acting on plantar flexion (toe pointing) and knee flexion.

When the connection between the strong tendon and the heel bone is compromised, the result is strain, microtrauma, and pain.

Because this connection point is particularly vulnerable after a growth spurt, young people are particularly susceptible to this condition.

Other contributing factors include repetitive sports activity such as running, tight ankles, and high impact activity in worn out, unsupportive shoes.

Although Sever’s disease is diagnosed by a doctor, surgery or invasive practices are not treatments for this condition.

Your doctor may want to take an X-ray to determine that there’s no fracture. Treatment is relatively simple, and most cases of Sever’s disease will resolve with rest.

If the pain is found to be a result of Sever’s disease, rest and letting the patient’s bones to grow to maturity will ultimately eliminate this condition. While healing, the condition can be helped with nonsteroidal anti-inflaamatory drugs NSAIDs (such as ibuprofen), icing, and calf stretching.

If activity modification and other more conservative treatments fail to help the pain, a healthcare professional may apply a cast to the area, though it’s usually not necessary.

Dr. Emily Splichal, DPM, a podiatrist, human movement specialist, and educator, says that she treats Sever’s disease in a child very similarly to the way she treats Achilles tendinitis in an adult.

Splichal recommends immobilization, heel lifts, soft counter shoes, and night splints for 2 to 4 weeks. When the injury starts to heal, she suggests focusing on soft tissue mobilization and Achilles tendon elasticity training.

Kinesiology tape is another method that may reduce the pain of Sever’s disease. It’s a special kind of tape that can be used to position pressure points on the skin to reduce pain.

Although studies are largely inconclusive on its effectiveness, taping continues to be popular among amateur and competitive athletes. Users sometimes report feeling stronger or more resistant to injury. With Sever’s disease in particular, there does appear to be an immediate reduction in pain with taping.

Splichal recommends waiting to use kinesiology tape until the healing has begun rather than applying it during the acute inflammation period.

Once a diagnosis has been made, the main recommendation will be rest, although certain exercises may be allowed. These exercises can also reduce the likelihood of getting this inflammation in the first place.

The following tips can help you exercise properly:

  • Wear newer, well-cushioned shoes, especially when engaging in impact-based or athletic moves.
  • Stretch after workouts, especially muscles of the calf, while the muscle is warm.
  • Work on ankle mobility outside of regular workouts. Consider adding exercises ankle circles, heel raises (1-leg and 2-leg), heel drops (1-leg and 2-leg), toe raises, and seated hamstring stretch with a yoga strap for foot flexion.
  • Cross-train with non-impact activities such as swimming or cycling to supplement fitness without too much ground force on the heel.
  • Consider a heel cup or orthotic if recommended by a physician.
  • Rest or modify when symptoms are first noticed.

Splichal recommends not stretching in the initial stages of the injury until tenderness and irritation have subsided. At that point, she recommends self-myofascial release (SMR) to the plantar foot (the bottom of the foot) and soleus (the lower calf muscle around the Achilles tendon).

How long does Sever’s disease last?

Usually pain lasts for around 2–8 weeks, but if the underlying causes are not addressed, it can last several months, or even until the growth plate is mature.

What’s the fastest way to get rid of Sever’s disease?

The quickest way to ease the pain of Sever’s disease is to rest, meaning that sports practice and exercise may be out of the question during the initial healing period.

You can avoid developing this condition again by stretching, doing mobility exercises, and cross-training. Wearing properly fitting, supportive shoes, using kinesiology tape, and using heel cups or orthotic inserts can also help.

Can you still play sports with Sever’s disease?

Continuing to stress an overuse injury rarely produces a good result. By powering through, you risk making the injury worse, or creating a muscular imbalance by favoring the affected foot that could produce long-term consequences.

If the injury is very minor, it’s possible to treat it with taping, but most doctors will recommend that you stop playing sports while healing.

How do you test for Sever’s disease?

A positive test for pain on the inside and outside of the calcaneus (heel bone) will strongly suggest Sever’s disease.

Many doctors will want to back up this diagnosis with an X-ray to rule out other causes of the pain, such as fracture or infection.

What type of doctor do you see for Sever’s disease?

It’s possible for your regular doctor to determine whether you have Sever’s disease, but a podiatrist or an orthopedic specialist is a good option for those who prefer a specialist.

Do you need a boot for Sever’s disease?

Certain ankle injuries have been shown to improve more quickly with a walking boot, but there’s little data for its use with Sever’s disease.

Based on the possibility of creating a muscle imbalance, it seems like a good idea to check with a doctor before taking on this treatment.

Can Sever’s disease be permanent?

No. Once the growth plate is mature at around 13–15 years of age, Sever’s disease is no longer a concern.

Sever’s disease is a fairly common condition among young athletes. Many cases of Sever’s disease can be prevented with easy precautions such as stretching and wearing good shoes.

But calcaneal apophysitis may still be a problem, especially among young athletes who run or jump with great frequency.

Rest, mobility, anti-inflammatory medications, ice, and taping may offer relief. Although Sever’s disease should be taken seriously and treated appropriately, it’s not a problem that will persist into adulthood.