Risk factors and associated factors for calcaneal apophysitis (Sever’s disease): a systematic review

Abstract

ObjectivesThe aim of this review was to identify the potential intrinsic and extrinsic risk factors (RFs), associated factors (AFs) and consequences of developing calcaneal apophysitis (CA).DesignSystematic review.Data sourcesCochrane Library, Embase, Medline Ovid, PubMed, Web of Science and Evidence, searched from inception to April 2021.Eligibility criteriaWe included cohort, case–control and cross-sectional studies that were conducted in patients younger than 18 years who were exposed to RFs or who presented with factors associated with developing CA. Studies in languages other than English or Spanish were excluded.Data extraction and synthesisTwo reviewers worked independently to evaluate the risk of bias of included studies. The Newcastle–Ottawa Scale (adapted version) was used.ResultsA total of 736 studies were identified and 11 observational studies fully met the inclusion criteria, including 1265 participants with a mean age of 10.72 years. Four studies identified extrinsic factors, 10 identified intrinsic factors and three identified both. The extrinsic and intrinsic RFs, AFs and consequences of CA include limitation of ankle dorsiflexion, foot alignment, stiffness and mobility of the midfoot, plantar pressures and ground reaction force, body mass index, age, gender, presence of other osteochondroses and practice of sport. The risk of bias varied, being either moderate or low.ConclusionsRegarding the factors and consequences associated with CA (Sever’s disease), ankle dorsiflexion limitation is the most frequent intrinsic factor studied, followed by peak plantar pressures and foot malalignment. However, disagreements between the investigators of the included studies were found; in some cases, there is a lack of unanimity between different studies as to which factors are considered to be RFs, AFs and consequences.PROSPERO registration numberCRD42021246366.

Conservative Treatment of Sever’s Disease: A Systematic Review

“…Sever’s disease (SVD), also known as calcaneal apophysitis, was initially described by James Warren Sever in 1912 [ 1 , 2 , 3 ]. It is described as an overuse injury with an insidious onset of pain and is usually not related to a traumatic event [ 4 ].…”

“…It is described as an overuse injury with an insidious onset of pain and is usually not related to a traumatic event [ 4 ]. Histologically, it is defined as inflammation or bone edema resulting from a stress fracture in the secondary growth center of the calcaneus [ 2 ]. This inflammation arises due to repetitive traction forces from the triceps surae muscle on the calcaneal apophysis [ 2 ].…”

“…Histologically, it is defined as inflammation or bone edema resulting from a stress fracture in the secondary growth center of the calcaneus [ 2 ]. This inflammation arises due to repetitive traction forces from the triceps surae muscle on the calcaneal apophysis [ 2 ]. In addition, with X-Ray, it is possible to see an increase in the density of the epiphysis [ 3 ].…”

“…Sever’s disease stands as the most common cause of heel pain in children and young individuals [ 1 , 2 , 5 , 6 , 7 ], with an incidence of 3.7 per 1000 patients [ 1 , 2 , 5 ]. It is a common musculoskeletal disorder, representing between 2% and 16% of consultations in sports clinics [ 8 , 9 ] and accounting for 5.8–22.7% of repetitive stress injuries in children [ 10 , 11 , 12 ].…”

“…It is a common musculoskeletal disorder, representing between 2% and 16% of consultations in sports clinics [ 8 , 9 ] and accounting for 5.8–22.7% of repetitive stress injuries in children [ 10 , 11 , 12 ]. During the process of skeletal development, a remarkable fact is observed when the calcaneal process remains in an open state [ 7 , 13 ], with more prevalence observed in girls between 7 and 9 years and boys between 8 and 15 years, peaking between 10 and 12 years of age [ 2 , 14 ]. Pain tends to be bilateral and asymmetrical [ 14 ].…”