Description

• A frequent cause of heel pain in children and adolescents resulting from a traction apophysitis of the calcaneal apophysis
• Frequently associated with repetitive use and sports participation

Epidemiology

Incidence

• The incidence is not currently known.
• In a cross-sectional study from the European Journal of Pediatrics done by Wiegerinck et al. published in 2014, 16,383 SOAP files from patients 6 to 17 years old visiting their general practitioner between 2008 and 2010 were analyzed and 61 children were identified with an incidence of 3.7 per 1,000.

Prevalence

• The prevalence is not currently known.
• In a study done by Suzue et al. published in 2014, 1,162 junior soccer players were evaluated by questionnaire and 49 were diagnosed by exam and imaging as having Sever disease (1).

Etiology and Pathophysiology

• Microtrauma occurs at the calcaneal apophysis as a result of repetitive traction on the calcaneal epiphysis by the Achilles tendon during concentric plantar flexion and eccentric dorsiflexion (2).
• Inflammation at the apophysis leads to pain and possible limping with activity.

Genetics
There is not a genetic predisposition to this condition.

Risk Factors

• Males are affected more often than females.
• Times of rapid growth lead to increased bone length and increased tension of the muscle-tendon unit on the bony attachment.
• Biomechanical malalignment may be a risk factor (3)[C].

General Prevention

• Stretching and strengthening of gastrocnemius–soleus complex
• Wear appropriate footwear with adequate heel support.
• Intermittent periods of rest from aggressive physical activity and adequate recovery periods following individual bouts of exercise

Commonly Associated Conditions

Foot pronation, arch abnormalities (pes planus or cavus), plantar fasciitis