Sever's disease (calcaneal apophysitis) is heel pain associated with inflammation at the calcaneal epiphysis. It is a common cause of heel pain in children and adolescents, prior to closure of the epiphysis. Apophysitis may be the result of overuse with repetitive microtrauma.

An apophysis is a protuberance of bone that is the site of muscle attachment. The calcaneal apophysis is where the Achilles tendon inserts.


Clinical features:

(1) heel pain, unilateral or bilateral

(2) age of patient typically from 5 to 11 years

(3) pain with weight-bearing

(4) tenderness at the apophysis

(5) pain on passive dorsiflexion


Radiographic findings:

(1) normal

(2) sclerosis or irregularities of the apophysis


Risk factors:

(1) jumping sports

(2) running sports, including soccer

(2) foot malalignment


Differential diagnosis:

(1) Achilles tendinopathy

(2) calcaneal fracture

(3) other causes of heel pain

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