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Adv Emerg Nurs J. 2019 Jan/Mar;41(1):10-14. doi: 10.1097/TME.0000000000000219.

Sever's Disease (Calcaneal Apophysitis).

Author information

School of Nursing and Health Sciences, Robert Morris University, Moon Township, and Emergency Department, Heritage Valley Esmark, Sewickley, Pennsylvania (Dr Ramponi); and Heritage Valley Health System, Sewickley, Pennsylvania (Ms Baker).


Sever's disease, or calcaneal apophysitis, is the primary cause of heel pain in pediatric patients between the ages of 8 and 15 years. Primary risk factors in pediatric athletes are obesity and high levels of physical activity. Sever's injury primarily results from high-impact sports such as soccer, track, cross-country, gymnastics, tennis, and ballet. This injury mainly occurs during puberty with an open growth plate in the immature calcaneus. Clinical diagnosis can be confirmed by performing a "squeeze test" of the heel on physical examination. Diagnostic imaging findings include increased sclerosis and fragmentation of the calcaneal apophysis on plain radiograph x-rays. Ice, activity restriction, stretching, nonsteroidal anti-inflammatory drugs, immobilization, and heel cups are all methods that can be utilized in treating the pain caused by Sever's. No long-term effects have been associated with Sever's disease.

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