Sever's disease

Disclaimer

These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Introduction

Sever’s disease is a common cause of heel pain in active 7 to 14 year olds and is thought to be the result of micro trauma on the growth plate of the calcaneus.

During periods of rapid growth there may be a discrepancy in the growth rates of long bones, muscles and tendons resulting in increased tension across the growth plate causing heel pain.

Sever’s disease may occur unilaterally or bilaterally. There will be pain in the heel and around the Achilles tendon. Activities such as running and jumping will aggravate the area with the child possibly tiptoeing to limit discomfort.

Sever’s disease is a self-limiting condition that will resolve with rest and other conservative measures. While it may return as growth continues, Sever’s disease will not return once the foot reaches skeletal maturity.

Pre-referral investigations

  • Obtain a history: activity, pain characteristics, any management.
  • Physical examination: palpation will elicit tenderness. 
  • X-rays will not confirm Sever’s disease but may be used to rule out other causes of pain.

Pre-referral management

  • Conservative measures: short term limitation of activities such as running and jumping, modifying activities as required, ice after pain inducing activity and simple analgesia.
  • Heel pads and well-fitting sports shoes may assist.
  • Gentle Achilles stretches after the acute episode has resolved.
  • Provide reassurance that Sever’s disease responds well to conservative measures and any flare-ups can be managed in the same way. Sever’s disease does not cause long term problems.
  • Consider weight management advice if obesity is thought to be contributing to the development of Sever’s disease.

When to refer

  • Sever’s disease is a self-limiting condition that generally responds well to conservative measures - referral for orthopaedic review is not routinely required.
  • Refer to the Orthopaedic Department if diagnosis is in doubt.

How to refer

Essential information to include in your referral

  • History of condition including pain characteristics, impacts on activities and treatments. 
  • Reasons why you are concerned that this is not Sever’s Disease. 

References

  1. Howard R. Diagnosing and treating Sever's disease in children. Emerg Nurse. 2014 Sep;22(5):28-30. PubMed PMID: 25185924. Epub 2014/09/05. eng.
  2. Hussain S, Hussain K, Hussain S, Hussain S. Sever's disease: a common cause of paediatric heel pain. BMJ Case Rep. 2013 May 27;2013. PubMed PMID: 23715840. Pubmed Central PMCID: PMC3669931. Epub 2013/05/30. eng.
  3. Hospital TRCs. Sever's Disease Melbourne: The Royal Children's Hospital 2011.
  4. Department of Health State Government of Victoria. Sever's Disease [Webpage]. Victoria: Department of Health State Government of Victoria,
    ; 2020 [cited 2021 May]. Available from: https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/severs-disease.

Reviewer/Team: Dr Kate Stannage, Orthopaedics Dept, PCH Last reviewed: Sep 2021


Review date: Sep 2022
Endorsed by:

Fast track approval Date:  Sep 2021


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