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Sever's Disease Cheat Sheet (DRAFT) by

Hx, presentation, DDx, imaging, management

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Sever's Disease


- Painful inflam­mation of the cartil­aginous growth at the site of the calceaneal tendon insertion
- Children most likely to suffer from this due to the growth plate being 2-5 times weaker than in adults
- Bone lengthens rapidly, soft tissues become tighter, produces strain on bony attach­ments
- Calcaneal apophysis subjected to signif­icant shear loads because of its vertical orient­ation and direction of pull from the gastro­csoleus
- Commonly found in athlet­ically active popula­tions aged 8-14
- Higher incidence in males
- Can present bilate­rally


- Progre­ssive posterior heel pain
- Worse with activity (usually limps)
- Better with rest
- Pain upon palpation of achilles insertion and squeeze test (squeezing medial and lateral calcaneus)
- Mild swelling might be present
- Active plantar flexion and toe raises and passive dorsif­lexion can be uncomf­ortable
- Looks for gastro­-soleus weakness, joint hypomo­bility, poor lower extremity biomec­hanics (excessive foot pronat­ion), inappr­opriate or excessive training, improper footwear, running on hard surfaces and excessive weight


- Rule out f#, neoplasm, osteom­yel­itis, bone cysts, foreign bodies (ongoing pain, pain at rest, pain that wakes patient up, signif­icant swelling, fever, consti­tut­ional symptoms, signif­icant loss of subtalar motion
- Can impact ADLs if left untreated


- Ice (Pre and post sports)
- Myofascial releas­e/s­tre­tching of calves
- Orthotics (1/2 inch heel lifts - eases shear on calves)
- Reduce frequency and intensity of exercise, limitation of running and jumping, cycling and swimming
- Reassu­rance
- When squeeze test is not painful - strengthen foot stabil­isers and calves
- Usually resolves within 2-8 weeks, if severe consider and CAM walking brace for 2-3 weeks