Calcaneal apophysitis (Sever's disease) in children: diagnosis and management

Calcaneal apophysitis, or Sever's disease, is a traction apophysitis of the calcaneal apophysis and one of the most frequent causes of heel pain in children and adolescents. This narrative review synthesizes the evidence on its diagnosis and conservative management. The condition presents with activity related heel pain, tenderness over the apophysis and a positive calcaneal squeeze test, and radiographs, ultrasound and magnetic resonance imaging are used to exclude alternative causes rather than to establish the diagnosis. Risk is higher with obesity, high impact sport and male sex, and repetitive traction on an immature apophysis modulated by skeletal maturity underlies the process. Randomized trials show comparable short term benefit from wait and see, heel lifts, foot orthoses, braces and exercise, without superiority of one modality. The course is self limited and most children return to sport within weeks with preserved function. Standardized diagnostic criteria, a core outcome set and longer randomized trials remain the priorities for future research.