Sever’s Disease (Calcaneal Apophysitis)

Sever's Disease (Calcaneal Apophysitis)

Explanation of Diagnosis

Sever’s disease is a growth plate inflammation in the heel bone (calcaneus) caused by repetitive stress and pulling from the Achilles tendon. It commonly affects active children and adolescents (ages 8-14), especially those in running or jumping sports. Symptoms include heel pain, tenderness, swelling, and stiffness, particularly after activity. It is not a true disease but rather a temporary growth-related condition that improves with proper management.

Specific Work Modifications

  • If work requires prolonged standing or walking, take breaks and elevate the foot when possible.
  • Wear cushioned, supportive shoes with a slight heel lift to reduce stress on the Achilles tendon.
  • Use heel cups or gel inserts to absorb impact and relieve heel pressure.
  • Avoid walking barefoot on hard surfaces.

Specific Activity Modifications

  • Avoid high-impact activities (running, jumping, basketball, soccer) until pain improves.
  • Modify workouts by switching to low-impact activities like swimming or cycling.
  • Use proper warm-ups and stretching routines before returning to sports.
  • Gradually reintroduce activities once pain resolves, using heel support.

Recommended Supplements

  • Calcium (1000-1200 mg daily) – Supports bone growth and repair.
  • Vitamin D3 (1000-2000 IU daily) – Enhances calcium absorption.
  • Magnesium (300-400 mg daily) – Aids in muscle relaxation and recovery.
  • Collagen peptides (10 g daily) – Supports tendon and ligament health.
  • Omega-3 fatty acids (1000 mg daily) – Reduces inflammation in the heel.

Recommended Nutrition and Hydration

Diet Recommendations:

  • Bone-supporting foods: Dairy, leafy greens, almonds, and fortified cereals.
  • Anti-inflammatory foods: Fatty fish, turmeric, berries, and walnuts.
  • Protein-rich foods: Chicken, eggs, lentils, and dairy to support growth and repair.
  • Limit processed foods, excess sugar, and soda, which can weaken bone health.

Hydration Tips:

  • Drink at least 2–3 liters of water daily to support joint and tissue health.
  • Limit sugary drinks and caffeine, which can interfere with calcium absorption.

Home Exercise Prescription

Perform 2-3 times daily to reduce pain and improve flexibility:

Stretching & Mobility

  1. Calf Stretch (Straight & Bent Knee)
    • Stand facing a wall, place one foot back, and keep the heel on the ground.
    • Hold for 20-30 seconds, repeat 3 times per leg.
  1. Plantar Fascia Stretch
    • Sit and pull your toes back toward your shin.
    • Hold for 20-30 seconds, repeat 3 times per foot.
  1. Rolling Massage with a Ball
    • Use a tennis ball or frozen water bottle under the foot and roll it gently.
    • 1-2 minutes per foot, 1-2 times daily.

Strengthening & Stability

  1. Heel Raises
    • Stand and slowly raise onto your toes, then lower.
    • 10 reps, 2 times daily.
  1. Toe Towel Scrunches (Arch Strengthening)
    • Place a towel under your foot and use your toes to scrunch it toward you.
    • 10 reps, 2 times daily.
  1. Single-Leg Balance Exercise
    • Stand on one foot for 15-30 seconds, increasing time as tolerated.
    • Repeat 2-3 times per leg.

Avoid excessive running, jumping, and high-impact activities until symptoms improve.

Helpful Books

  1. "Sports Injuries Guidebook" – Robert Gotlin, DO
  2. "The Young Athlete’s Guide to Sports Medicine" – Jordan Metzl, MD

Contact the Key West orthopedic clinic or reach out to Dr. Jason Pirozzolo.

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