Calcaneal apophysitis (Sever's disease)

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Counseling

Sever's disease is common during growth spurts and goes away when the heel growth center matures in the early teens. Recommended supportive care with an emphasis on calf stretches, supportive shoes, and adjusting activity to pain. Return precautions given including swelling or redness of the heel, limping that does not settle, night pain, fever, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Calcaneal apophysitis (Sever's disease)
• Positive calcaneal squeeze test; x-ray not needed given a typical presentation
• Limit running and jumping to what pain allows, with low-impact cross-training
• Ice after activity and motrin as needed
• Calf stretches several times a day
• Heel cups or heel lifts, with arch supports if needed, in sports shoes and cleats
• Physical therapy referral
• Follow up as needed

Sever's disease is common during growth spurts and goes away when the heel growth center matures in the early teens. Recommended supportive care with an emphasis on calf stretches, supportive shoes, and adjusting activity to pain. Return precautions given including swelling or redness of the heel, limping that does not settle, night pain, fever, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Clinical diagnosis; x-ray if refractory unilateral
Activity modification, ice, NSAID, calf stretches, heel cups
Ages and maturation

Return precautions in the template

swelling or redness of the heellimping that does not settlenight painfever

Sources

Sport-Related Concussion in Children and Adolescents. Clinical Report. Pediatrics 2018;142(6):e20183074. (newest AAP concussion CR found; also Early Childhood…
Overuse Injuries, Overtraining, and Burnout in Young Athletes. Clinical Report. Pediatrics 2024;153(2):e2023065129. (replaces earlier report)
Early Childhood Concussion. State-of-the-art review. Pediatrics 2024;154(5):e2023065484 (not an AAP policy)

Few formal guidelines cover this topic, so the template also leans on expert opinion.