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Sever's Disease (Calcaneal Apophysitis)

Ramponi, Denise R., DNP, FNP-C, ENP-BC, FAEN, FAANP, CEN; Baker, Caron, MSN, BSN, RN

Section Editor(s): Ramponi, Denise R. DNP, FNP-C, ENP-BC, FAEN, FAANP, CEN; Column Editor

Advanced Emergency Nursing Journal: January/March 2019 - Volume 41 - Issue 1 - p 10–14
doi: 10.1097/TME.0000000000000219

Sever's disease, or calcaneal apophysitis, is the primary cause of heel pain in pediatric patients between the ages of 8 and 15 years. Primary risk factors in pediatric athletes are obesity and high levels of physical activity. Sever's injury primarily results from high-impact sports such as soccer, track, cross-country, gymnastics, tennis, and ballet. This injury mainly occurs during puberty with an open growth plate in the immature calcaneus. Clinical diagnosis can be confirmed by performing a “squeeze test” of the heel on physical examination. Diagnostic imaging findings include increased sclerosis and fragmentation of the calcaneal apophysis on plain radiograph x-rays. Ice, activity restriction, stretching, nonsteroidal anti-inflammatory drugs, immobilization, and heel cups are all methods that can be utilized in treating the pain caused by Sever's. No long-term effects have been associated with Sever's disease.

School of Nursing and Health Sciences, Robert Morris University, Moon Township, and Emergency Department, Heritage Valley Esmark, Sewickley, Pennsylvania (Dr Ramponi); and Heritage Valley Health System, Sewickley, Pennsylvania (Ms Baker).

Corresponding Author: Denise R. Ramponi, DNP, FNP-C, ENP-BC, FAEN, FAANP, CEN, School of Nursing and Health Sciences, Robert Morris University, Moon Township, PA 15108 (

Medical illustrations by Nicole Eaton, Media Arts Student, Robert Morris University.

Disclosure: The authors report no conflicts of interest.

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