Sever’s disease is a painful condition of the heel in growing children. It may frequently occur after significant activities such as running or jumping. The children have difficulty putting pressure on the heel and frequently will begin walking on their toes.
The actual pathology of the condition is one of more of an overuse syndrome in which the growth plate of the heel may become slightly displaced, causing pain. Biopsies of similar conditions have shown changes consistent with separation of the cartilage. The condition is very similar to Osgood-Schlatter’s disease which occurs at the knee.
The general feeling is that there is stress placed on the growth plate and this causes microfractures between the growth plate and the rest of the bone of the heel.
The condition is self-limited, however, it may take a prolonged period of time until it completely resolves.
Treatment revolves around decreasing activity. Our usual treatment has been putting children in a boot in slight equinus, or a cast with the foot in slight equinus, thereby decreasing the tension on the heel cord, which in turn pulls on the growth plate at the heel. As the pain resolves, children are allowed to go back to full activities.
Complete resolution my be delayed until growth of the foot is complete — when the growth plate fuses to the rest of the bone of the heel.
Text by Saul M. Bernstein, MD
Southern California Orthopedic Institute