Sever’s Disease (Calcaneal Apophysitis)

Question 1

Apophysis

Answer 1

Located at the posterior calcaneus which is not fully formed until 15-17 years of age (puberty)

Question 2

Pathophysiology

Answer 2

Tight heel cord causes excessive traction on growing apophysis creating inflammation, atraumatic, repetitive microtrauma due to sporting activities and repetitive loading

Question 3

Demographics

Answer 3

Males/boys, 10-12 years of age, this disease does NOT happen after puberty, most common cause of posterior heel pain in pre-pubescent boys

Question 4

Signs/Symptoms

Answer 4

No pain on rest or in the morning, pain on activity (running, jumping), limp at end of physical activity, pain with heel compression, no redness or swelling typically found, and bilateral in 60% of cases

Question 5

Diagnostic Imaging

Answer 5

Diagnosis of exclusion, if NPTE asks… put plain film radiograph to rule out fracture

Question 6

Examination

Answer 6

Passive DF that is painful, tenderness on palpation, no swelling or redness, (+) squeeze test

Question 7

Squeeze Test

Answer 7

Mediolateral compression of posterior lower 1/3 of calcaneus and squeeze these sides together (different than the squeeze test for mortons neuroma)

Question 8

Prognosis

Answer 8

Self limiting condition with a good to excellent prognosis

Question 9

Impairments

Answer 9

Heel pain, decreased ROM, limited DF, weakness of DF

Question 10

PT Management

Answer 10

Activity modification, cessation of sport/activity, cryotherapy, ultrasound (low dose for child to treat inflammation), heel lift in shoe to put gastroc on slack and place pressure on forefoot, stretch gastroc, and strength anterior tib and extensor digitorum

Question 11

Side Note**

Answer 11

Corticosteroid injections are contraindicated in this condition (because when injected in this area they can break down the tendon)