Sever's disease is a traction apophysitis of the calcaneous seen in children ages 7 to 13. Some studies suggest that the etiology of Sever's disease may be more stress related as opposed to a true traction apophysitis. Insidious onset of heel pain with running is the hallmark symptom. Pain can be elicited with the calcaneal squeeze test (squeezing the medial and lateral portions of the calcaneous together) and palpation of the Achilles insertion onto the calcaneous. As long bone growth may precede tendon and ligamentous growth, many children with calcaneal apophysitis have tight heel cords on examination. Radiographs show a normal appearing apophysis and are not clinically necessary. Soccer players seem to be particularly plagued with this "growing pain" as soccer shoes provide very little cushioning or support. Daily physical therapy to increase flexibility of the gastrocnemius/Achilles complex along with heel cups is helpful in alleviating symptoms. Ice massage for 15 to 20 minutes after activity also controls pain. All conditioning and running should be done in proper running shoes as opposed to cleats when possible. Athletes may participate in sports as long as they are not limping or having a significant increase in pain. Pain usually resolves completely when the apophysis ossifies, around ages 13 or 14.
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