Epiphysitis of the Calcaneus
(Sever Disease; Sever's Disease)
(See also Overview of Foot and Ankle Disorders.)
Epiphysitis of the calcaneus is painful disruption between the calcaneal apophysis and the body of the heel that occurs before calcaneal ossification is complete. Diagnosis is clinical. Treatment is with heel pads and splinting or casting.
The calcaneus develops from two centers of ossification: one begins at birth, the other usually after age 8. Ossification is usually complete by age 15. The cartilaginous disruption in calcaneal epiphysitis may result from an excessive pull on the apophysis by contracted or shortened calf muscles. Bone growth spurts without adaptive calf muscle lengthening may play a role.
Pain develops in patients (usually aged 9 to 14) with a history of athletic activity, especially those who wear footwear without elevation of the heel (such as track flats or soccer cleats); it affects the sides or margins of the heel and is aggravated by standing on tip toes or running. Warmth and swelling are occasionally present.
The diagnosis is clinical. X-rays are not usually helpful.
Pads that elevate the heel relieve symptoms by reducing the pull of the Achilles tendon on the heel. Night splints may be used to passively stretch the calf muscles, helping maintain flexibility. Rest, ice, activity modifications, and the use of heel pads usually relieve pain. In more severe or recalcitrant cases, cast immobilization may be used to relieve pain and stretch the calf muscles. Reassurance is important because symptoms may last several months but are self-limiting.