Current concept review of Sever's disease in paediatric age group

Abstract

Background: Sever's disease is directly associated with excessive usage of the heel bone and tendons. This may occur from any sports involving a lot of heel movement. The commencement of new sport or the beginning of new season may be linked with it. Children through puberty are particularly at danger since the heel bone is growing faster than the leg. The objective of this research was to conduct a current concept study on severity in the paediatric age range. Methods: This is an article of review, Searches in MEDLINE and Embase, Pubmed and CINAHL Plus were carried out within the same date period as follows: "Sever's disease; paediatric; orthopaedics." The most obvious sign of severe illness is heel discomfort, typically exacerbated by physical activity like walking, jogging, or skipping. Sometimes the discomfort may be so intense that it limps and affects physical performance in athletics. Sever's disease is most often clinically diagnosed and many doctors feel that radiographic assessment is unnecessary, however if calcaneal apophysitis is not identified without x-rays, an injury needing more severe treatment may be overlooked. Edematous alterations in calcaneal apophysis may occur via MRI, which may spread to neighbouring calcaneal tuberosity, The research indicates that most people with the Sever illness are able to return to sport in a few weeks to two months with appropriate management.

‘Severs Disease’ – Manifestations & Management

“…The calcaneum is the largest bone in the foot. The insertion of the Achilles tendon occurs in the posterior aspect near the apophysis [1,6]. The apophysis is generally considered the weakest area which is subject to axial load stress.…”

“…The apophysis fuses by approximately 13 years in girls and 15 years in boys. The muscle tendon unit loses its peak flexibility due to excessive bone growth during the growth spurt leading to increased loading and stresses across the un-ossified apophysis which is believed to be initiated by excessive activity [1,6]. The exact mechanism is still unknown but the currently recognized theory is that it is an overuse injury secondary to increased shear stress, and repetitive impact pressures due to micro trauma across the apophysis.…”

“…Although an incidence of 3.7/1000 patients [4] has been reported, this condition is underreported and its true prevalence is unknown [1,5]. T h i s c o n d i t i o n i s a t t r i b u t e d t o inflammation of the heel growth plate in physically active growing children [1,5,6] and is currently described as being an o v e r u s e i n j u r y w i t h r e p e t i t i v e microtrauma ex perienced during physical activities. Evidence suggests no correlation to a traumatic event and usually presents with insidious onset heel pain after sports or physical activity [1,5,6].…”

“…T h i s c o n d i t i o n i s a t t r i b u t e d t o inflammation of the heel growth plate in physically active growing children [1,5,6] and is currently described as being an o v e r u s e i n j u r y w i t h r e p e t i t i v e microtrauma ex perienced during physical activities. Evidence suggests no correlation to a traumatic event and usually presents with insidious onset heel pain after sports or physical activity [1,5,6]. Adolescents are particularly in more danger due to physiological changes reducing muscle-tendon unit flexibility causing increased stress at incompletely ossified apophysis [1,5,6].…”

“…Evidence suggests no correlation to a traumatic event and usually presents with insidious onset heel pain after sports or physical activity [1,5,6]. Adolescents are particularly in more danger due to physiological changes reducing muscle-tendon unit flexibility causing increased stress at incompletely ossified apophysis [1,5,6]. Despite its prevalence, not many studies exist in medical literature and with this article, we would like to put forth a brief over v iew of cur rent concepts in understanding and managing this condition.…”