Bilateral sever´s disease–an uncommon finding

Abstract

Calcaneal apophysitis is a common cause of heel pain in children and is also known as Sever´s disease. Rarely causes important disability and is transient in most of the times, but it can interfere with walking and physical performance in sports, causing concern to the patient and parents. It is the most common cause of heel pain in the physically active growing children–8-25 years-old–and is considered a benign, self-limiting condition of childhood and adolescence. Boys constitute two-thirds of the patients and the sport that tends to dominate is soccer. The diagnosis of calcaneal apophysitis is usually made with a typical history and physical examination. Pain with activity, especially running and jumping, and a positive “squeeze test”: pain is produced by medial and lateral compression of the heel where the calcaneal apophysis attaches to the main body of the calcaneus. Children with Sever’s disease don´t have growth disturbances in the calcaneal apophysis or any vary in bone density compatible with a necrotic or a repair process. Children with Sever’s disorder respond variably, poorly, or not at all to anti-inflammatory drugs. Heel cup fixating the heel pad provided better pain relief in young boys with Sever’s injury compared with the traditional heel wedge.