Sever’s Disease of the Pediatric Population: Clinical, Pathologic, and Therapeutic Considerations

Abstract

Sever's disease is an underreported prevalent pediatric condition that causes heel pain in children worldwide. It is often described as an overuse injury that can present with either unilateral or bilateral heel pain. Even though the exact mechanism of injury is unknown, it is often thought it involves repetitive stress and pressure on the calcaneal growth plate. Diagnosing Sever's disease mainly relies on a thorough clinical investigation and physical examination, with a positive squeeze test usually sufficient to establish diagnosis. Nevertheless, radiographic imaging can help exclude other differential diagnoses. Therapeutic options of Sever's disease are mostly conservative, and these include rest, physical therapy, kinesiotherapy, and orthoses. Educating parents and coaches on the symptomatology and presentation of Sever's disease is pivotal for the establishment of efficient preventive interventions and earlier diagnoses. This study presents a case of a pediatric patient with Sever's disease and offers medical insight into the diagnostic, clinical, pathologic, and therapeutic characteristics of this condition, in light of the current existing literature.

‘Severs Disease’ – Manifestations & Management

“…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].…”

“…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.…”

“…Posterior heel pain is a common presentation, especially in active children or adolescents ages 8-15 [1,2]. Sever's d i s ea s e i s a co m m o n i d i o pat h i c condition, first described by an American orthopaedic specialist James Warren Sever in 1912 [3].…”

“…Sever's d i s ea s e i s a co m m o n i d i o pat h i c condition, first described by an American orthopaedic specialist James Warren Sever in 1912 [3]. 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.…”

“…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].…”