Sever’s Disease

What is it?

Sever’s lesion refers to an injury to the bone growth plate at the back of the heel bone (calcaneus) in young athletes. It is more a condition than a disease.

How does it happen?

The large calf muscles (gastrocnemius and soleus) attach to the heel via the Achilles tendon. The function of this tendon is to transmit forces produced by the calf muscles to the heel bone. In children, the portion of the heel bone into which the Achilles tendon inserts is separated from the bulk of the heel bone by a growth plate. This growth plate enables bone growth to occur. However, it also represents a site of weakness in the bone. Forcible and repeated contraction of the calf muscles can injure the growth plate. This commonly occurs during a period of rapid growth where the muscles and tendons become tighter as the bones grow. This leads to increased pulling of the calf muscles and Achilles tendon on the heel bone and growth plate.

How does it feel?

Sever’s lesion is experienced as pain at the back of the heel where the Achilles tendon inserts into the heel bone. This is felt most commonly during activity. The back of the heel may also be tender to touch and there may be localised swelling.

What should you do?

If your child has pain at the back of the heel and you think it may be Sever’s lesion, you should consult a sports physiotherapist for assistance. In the meantime, you should limit their participation in their chosen sport/s to restrict the amount of damage to the growth plate.

What shouldn’t you do?

If you think your child has Sever’s lesion, you should not encourage them to exercise and exercise through the pain.

Could there be any long-term effects?

Sever’s lesion does not produce any long-term effects. It will not interfere with their growth and the pain will settle. This usually occurs within six to twelve months.

Management

The assistance of a Sports and Exercise Physiotherapist is important in the treatment of Sever’s lesion. Initially, they can assist in diagnosing the injury and the extent of the damage. From this, they will be able to determine an appropriate management plan. This may involve an initial period of rest or activity modification, soft tissue treatment such as massage and stretching, correction of your biomechanics using either a simple heel raise or orthoses, and the progression through a series of specific strengthening exercises. In addition, they will be able to advise you and your child on the appropriate time for return to full participation.

Tom is a physio in Balgowlah who is highly trained in the assessment and management of all adolescent conditions. For a complete understanding of your heel pain (or your child’s), you will need an assessment face-to-face. To see the most highly regarded physio in Balgowlah, book here.

Brukner & Khan (2012) Clinical Sports Medicine.