Understanding Sever’s Disease: The Impact on Young Athletes
Next up in our blog series looking at and breaking down pain and injury in young people and youth athletes, Sever’s Disease.
Understanding Sever’s
Have you ever heard of or seen Sever’s?
Sever’s Disease is a condition which develops over the calcaneal apophysitis due to repetitive microtrauma because of the traction of the achilles over this area. In simple terms, Sever’s is a condition due to an increased load at the point where the achilles tendon meets with the base of the heel.
Causes of Sever’s
The cause of Sever’s commonly occurs from an increase of sporting or physical load. Sever’s is an Osteochondrosis; (self limiting development of normal bone growth as covered in our previous blog) often this results from repetitive running and jumping.
But how does this happen?
There isn’t one simple cause for Sever’s to occur. However, the literature defines consistent risk factors for youth athletes making them more susceptible to the condition. These risk factors include pubertal growth at the beginning or during a sporting season (1), weak ankle musculature, obesity, poorly fitting or cushioned shoes and biomechanical factors with how we walk, run and jump. (2)
Symptoms and Diagnosis of Sever’s
A subjective examination which typically will demonstrate the patient as being young and will present with a spike in physical activity.
Patients with Sever’s will also present with localised and specific tenderness on palpation over the calcaneal apophysis (directly over the heel bone). Swelling due to the increase in load the athlete may be undertaking may also be present over this area despite it being a non inflammatory condition.
The patient will typically have a decreased range of motion in the ankle and this may elicit a painful reaction; knee to wall testing in particular may be irritable for the patient. Furthermore, Physiotherapists or other health professionals may use special tests such as the Squeeze Test to further rule in or out Sever’s.
Additionally, radiographic imaging is typically not required. (3)
Treatment and Rehab of Sever’s
It is important to seek professional and collaborative medical treatment by both a Physiotherapist and a Medical Doctor. Injections and surgical intervention for Sever’s disease is not indicated.
Education is vital in the early stages of Sever’s, young athletes should be advised that with management, activity modification and a strong rehabilitation protocol, Sever’s will settle within six to 12 months.
Passively, patients will typically respond to a heel lift to restrict the stretch of the achilles tendon on the calcaneus. Orthotic intervention may also be appropriate.
Actively, a strengthening program focussing on progressively loading calf musculature and preparing for a return to sport is vital for successful rehabilitation. (2,3)
Do you have any questions about Sever’s? Do you or your child/young athlete have an injury?
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Launay, F. (2015) ‘Sports-related overuse injuries in children’, Orthopaedics & Traumatology: Surgery; Research, 101(1).
McSweeney SC, Reed L, Wearing S. Foot Mobility Magnitude and Stiffness in Children With and Without Calcaneal Apophysitis. Foot & Ankle International. 2018;39(5):585-590
Brukner, Peter. & Brukner, Peter. & Khan, Karim. (2017). Brukner & Khan’s clinical sports medicine