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Sever's Disease

What is Calcaneal Apophysitis? 

Calcaneal apophysitis is a painful inflammatory condition of the heel that occurs in children. It is often confused with plantar fasciitis, which usually occurs in adults.

This condition usually affects children between the ages of 8 and 14, but it can vary depending on the child’s growth patterns. It occurs at the exposed growth plate of the heel and can continue to be painful until the growth plate closes. The first doctor to describe this painful heel condition was Dr. Sever, so calcaneal apophystits is often referred to as Sever’s disease. However, that's a bit of a misnomer—it isn't really a true disease.


Overuse and stress on the heel bone can cause this condition. It is often exacerbated by sports or repetitive pounding of the heel and/or light running, and is quite common in kids who play basketball or soccer, especially at a high level. However, there are other possible causes, including genetic predisposition, tight Achilles tendons, flat feet, or a high-arched foot structure. Calcaneal apophysitis typically does not improve on its own and medical treatment is sought.


Most kids will notice pain in the back or the bottom of the heel. You may see your child limping or walking on their toes. Sometimes you can see some swelling or difficulty with running or jumping. 


The diagnosis is typically performed in the podiatric physician's office. Often times squeezing the heel from side to side can indicate calcaneal apophystis. However, a thorough medical history needs to be performed, as well as X-rays to rule out any other common causes. Often other advanced imaging needs to be performed. 


Your foot and ankle physicians may have many great treatment options. These can include immobilization, reduced activity, supporting of the heel, prescription orthotics, medication, and physical therapy. Some children will have a reoccurrence and should follow up with your foot and ankle position to make sure additional problems are developed.