The answer to whether an adult can develop Sever’s Disease, also known as calcaneal apophysitis, is no. This specific form of heel pain is anatomically restricted to growing children and adolescents. While adults frequently experience heel pain, the underlying cause is always a different condition. This is because the structure of the heel bone permanently changes upon reaching full physical development, eliminating the anatomical target for Sever’s Disease.
Understanding Sever’s Disease
Sever’s Disease is a common cause of heel pain in young, active people, typically affecting those between the ages of eight and 15 years. The condition involves inflammation at the back of the heel bone (calcaneus), specifically at the calcaneal apophysis. This apophysis is a temporary growth plate located where the Achilles tendon attaches to the heel bone.
The mechanical cause is repetitive stress and traction on this developing growth plate, often seen in sports involving running and jumping. The Achilles tendon connects the calf muscles to this area, and the constant pull irritates the softer, cartilaginous tissue. Symptoms include tenderness directly over the back and sides of the heel, with pain that worsens during physical activity and often causes a noticeable limp.
The Critical Role of Skeletal Maturity
The presence of the calcaneal apophysis is the factor that makes Sever’s Disease possible, and its eventual disappearance prevents the condition in adults. The apophysis is composed of cartilage, a tissue significantly weaker than mature bone. This weakness makes it susceptible to the traction and microtrauma of physical activity, which is why repetitive stress causes inflammation and pain in a child.
Skeletal maturity is the process by which this temporary cartilage structure is converted into solid bone, called ossification. The fusion of the calcaneal apophysis to the main body of the calcaneus typically begins in late childhood and is complete by late adolescence, generally between the ages of 14 and 17. Once this fusion is complete, the growth plate closes permanently, and the heel bone becomes a single, solid structure. The anatomical target for Sever’s Disease ceases to exist, making the diagnosis impossible for anyone who has reached skeletal maturity.
Common Causes of Adult Heel Pain
When adults experience pain at the back or bottom of the heel, it is due to a soft tissue injury or a stress reaction in the mature bone. The most frequent cause of adult heel pain is Plantar Fasciitis, which involves inflammation of the thick band of tissue running along the bottom of the foot. This condition causes sharp pain, usually localized to the underside of the heel, and is worst with the first steps taken in the morning or after a period of rest.
Pain felt higher up on the back of the heel is commonly diagnosed as Achilles Tendinopathy or Tendinitis, a degenerative or inflammatory condition affecting the tendon connecting the calf muscles to the heel bone. This pain is aggravated by physical activity like walking or running and can present with stiffness and swelling at the tendon insertion site. Chronic stress can also lead to a Calcaneal Stress Fracture, a hairline crack that develops in the mature bone from repeated impact. This type of fracture causes localized tenderness and pain that worsens with weight-bearing.
Another cause of adult heel pain is Bursitis, the inflammation of a fluid-filled sac called a bursa. Bursae act as cushions between tendons, bones, and skin. Inflammation of the retrocalcaneal bursa, located between the Achilles tendon and the heel bone, causes pain and tenderness at the back of the heel, often made worse by pressure from shoes. These adult conditions involve different anatomical structures, reflecting the biomechanical stresses placed on a mature skeletal system.