Sever’s Disease: An Underdiagnosed Foot Injury in the Pediatric Emergency Department

Michael Marchick,Henry Young,Mathew F Ryan

doi:10.4236/ojem.2015.34007

Abstract

Sever’s disease—also known as calcaneal apophysitis—is a common cause of heel pain in pediatric patients typically aged 7 - 14 years old. Sever’s disease can be painful and limit a child’s function as well as participation in physical activity. Herein, we described a case of delayed presentation of chronic Sever’s disease in a child who had been experiencing heel pain for over one year which worsened substantially when the child began to participate in sports. This is important for the emergency medicine physician because Sever’s disease represents an underdiagnosed cause of foot and heel pain in the pediatric patient and may be often missed. We describe the diagnosis and treatment options of Sever’s disease as well as associated controversies, e.g., whether activity is indeed the cause of Sever’s disease and whether imaging is needed for a diagnosis.

Highlights

IntroductionSever’s disease is inflammation of the calcaneal apophysis which can be painful and limit a child’s physical activity
Sever’s disease is inflammation of the calcaneal apophysis which can be painful and limit a child’s physical activity. It is one of the most common causes of heel pain in pediatric patients [1], often aged 7 - 14 years old and especially in those who are active in high-impact sports such as football, basketball or soccer [2]
Repeated pull and strain on the calcaneal apophysis during activity are thought to result in the accumulation of microscopic tears in the apophysis which eventually results in localized inflammation and subsequent pain [4]

Summary

Introduction

Sever’s disease is inflammation of the calcaneal apophysis which can be painful and limit a child’s physical activity. While most cases of Sever’s disease were associated with increased activity, our patient complained of heel pain for months, and was seen several times by his primary care physician, all the while walking predominantly shoeless prior to participating in sports. After he began an athletic program his pain was exacerbated and he was unable to further participate due to pain and discomfort. We note that it is important for the emergency medicine physician because the symptoms are prevalent, preventable, treatable, and often overlooked in the pediatric population

Case Report

Discussion

Conclusion