Severs Disease

Injuries > Achilles & Heel > Severs Disease

(Also known as Calcaneal Apophysitis)

What is Severs disease?

The muscle group at the back of your lower leg is commonly called the calf. The calf comprises of 2 major muscles (gastrocnemius and soleus) both of which insert into the heel bone via the Achilles tendon (figure 1). 

In people who have not reached skeletal maturity, a growth plate exists where the Achilles tendon inserts into the heel bone. This growth plate is primarily comprised of cartilage. Every time the calf contracts, it pulls on the Achilles tendon which in turn pulls on the heels growth plate. When this tension is too forceful or repetitive, irritation to the growth plate may occur resulting in pain and sometimes an increased bony prominence at the back of the heel. This condition is called Severs disease.

Severs disease is typically seen in children or adolescents during periods of rapid growth. This is because muscles and tendons become tighter as bones become longer. As a result, more tension is placed on the heels growth plate.

Signs and symptoms of Severs disease

Patients with Severs disease typically experience pain that develops gradually in the back of the heel or achilles region. In less severe cases, patients may only experience an ache or stiffness in the heel that increases with rest (especially at night or first thing in the morning) following activities requiring strong or repetitive contraction of the calf muscles such as running (especially uphill) or during sports involving running, jumping or hopping. The pain associated with this condition may also warm up with activity in the initial stages of the condition.

As the condition progresses, patients may experience symptoms that increase during activity and affect performance. Pain may also increase on firmly touching the affected region and occasionally a bony lump may be palpable at the back of the heel.

Treatment for Severs disease

Severs disease is a self limiting condition that gradually resolves as the patient moves towards skeletal maturity. This usually takes between 6 to 12 months but may persist for as long as 2 years. Patients with Severs disease typically improve gradually over time and full function is restored. Management primarily comprises of activity modification so the patient is pain-free.

Whether or not a patient should continue playing sport is dependent on symptoms. Patients with mild symptoms may wish to continue to play some or all sport, others may choose to modify their program. Generally it is recommended that patients keep active provided their symptoms are mild or absent.

Contributing factors to the development of Severs disease

There are several factors which may increase the likelihood of developing this condition. These need to be assessed and corrected with direction from a physiotherapist to ensure an optimal outcome. Some of these factors include:

• inappropriate footwear
• calf tightness
• calf weakness
• joint stiffness
• poor lower limb biomechanics
• poor foot posture
• inappropriate training

Physiotherapy for Severs disease

Physiotherapy treatment is vital for for patients with this condition to reduce pain, allow for increased activity levels and ensure an optimal outcome. Treatment may comprise:

• biomechanical correction
• the use of heel wedges
• activity modification advice
• soft tissue massage
• education
• the use of crutches
• electrotherapy
• icing
• taping
• exercises addressing any flexibility, strength or balance issues
• footwear advice
• a gradual return to activity program

Other intervention for Severs disease

Occasionally, a consultation with a podiatrist may be indicated to correct abnormal foot biomechanics and improve the condition. The treating physiotherapist can advise if this is required.

Exercises for Severs disease

The following exercises are commonly prescribed to patients with Severs disease. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 1 - 3 times daily and only provided they do not cause or increase symptoms.

Lunge Stretch

Begin this exercise with your hands against the wall. Place the leg to be stretched in front of you as demonstrated. Keep your heel down. Gently move your knee forward over your toes until you feel a stretch in the back of your calf or Achilles tendon (figure 2). Hold for 15 seconds and repeat 4 times at a mild to moderate stretch pain-free.

Figure 2 – Lunge Stretch (right leg)

Calf Stretch

Begin this exercise with your hands against the wall. Place the leg to be stretched behind you as demonstrated. Keep your heel down, knee straight and feet pointing forwards. Gently lunge forwards until you feel a stretch in the back of your calf, knee or Achilles tendon (figure 3). Hold for 15 seconds and repeat 4 times at a mild to moderate stretch pain-free.

Figure 3 – Calf Stretch (left leg)

Find a Physio for Severs disease

Find a physiotherapist in your local area who can treat this condition.

Other Exercises

View more calf flexibility exercises.

View calf strengthening exercises.

View balance exercises.

Physiotherapy products for Severs disease

Some of the most commonly recommended products by physiotherapist for patients with this condition include:

1. Ice Packs or Heat Packs
2. Heel Wedges
3. Wobbleboards or Duradiscs
4. Foam Rollers

To purchase physiotherapy products for Severs disease click on one of the above links or visit the PhysioAdvisor Shop.

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