Sever’s Disease (calcaneal apophysitis) is a common diagnosis for heel pain in young, physically active individuals. Adults experiencing similar discomfort often search for this condition. This specific type of heel pain is an inflammatory condition that occurs only during a particular phase of skeletal development. Adults cannot develop Sever’s Disease because the underlying biological structure required for the condition is absent in a mature skeleton. The painful symptoms adults experience are instead caused by other common orthopedic issues affecting the mature heel.
Understanding Sever’s Disease
Sever’s Disease is a traction injury affecting the growth plate (apophysis) at the back of the calcaneus (heel bone). This inflammation occurs at the secondary ossification center where the Achilles tendon attaches. Since the growth plate is cartilaginous, it is weaker than mature bone and susceptible to injury from repetitive stress.
The condition typically affects active individuals between 8 and 15 years old during periods of rapid growth. Repetitive microtrauma causes the powerful pull of the Achilles tendon to irritate the vulnerable growth plate. Pain usually intensifies during or after activity and is relieved by rest.
The condition is self-limiting, resolving completely once the skeletal structure matures. It often occurs when the bone’s growth rate temporarily outpaces the growth of surrounding muscles and tendons, creating increased tension on the soft apophysis.
Growth Plate Fusion and the Adult Heel
The fundamental reason adults cannot have Sever’s Disease lies in skeletal maturity. Sever’s Disease requires the presence of an active, unfused calcaneal apophysis—a temporary cartilaginous structure that allows the heel bone to lengthen during childhood.
Skeletal maturity is achieved through apophyseal fusion, where the cartilage of the growth plate is gradually replaced by solid bone. The calcaneal apophysis typically begins fusing in early adolescence and is fully closed by the late teens.
Once fusion is complete, the growth plate no longer exists. The heel bone becomes a single, solid osseous unit. Without this vulnerable, cartilaginous structure, the anatomical requirement for Sever’s Disease is absent, precluding the diagnosis in an adult.
Alternative Diagnoses for Adult Heel Pain
Adults experiencing heel pain often have symptoms that mimic Sever’s Disease, but the underlying causes differ. The most common diagnosis for pain on the underside of the heel is Plantar Fasciitis. This condition involves inflammation, degeneration, or strain of the plantar fascia, a thick band of tissue running along the bottom of the foot.
Plantar Fasciitis pain is characteristically sharp, often worst with the first few steps in the morning or after rest. Tenderness is localized to the bottom and inner side of the heel bone.
Another common cause of posterior heel pain is Achilles Tendinopathy, an overuse injury affecting the tendon connecting the calf muscle to the mature calcaneus. This typically causes pain, stiffness, and swelling near the tendon’s insertion point. Other potential diagnoses include calcaneal stress fractures and Haglund’s deformity, which causes retrocalcaneal bursitis.
Management Strategies for Heel Pain
The management of adult heel pain differs from the approach for pediatric Sever’s Disease because treatment targets mature, non-growing tissues. Sever’s Disease treatment involves relative rest, activity modification, and using heel cups to cushion the area until the growth plate naturally fuses, reducing stress on the growing bone structure.
For adult conditions like Plantar Fasciitis and Achilles Tendinopathy, the focus shifts to tissue repair and reducing chronic inflammation. Initial treatments often include physical therapy, specific stretching protocols, and supportive footwear or custom orthotics. Night splints are frequently used to keep the foot in a slightly stretched position overnight.
While Sever’s Disease resolves spontaneously, adult heel conditions can become chronic if not addressed. More intensive interventions, such as corticosteroid injections or extracorporeal shockwave therapy, may be used for recalcitrant cases. An accurate diagnosis is paramount, and any adult experiencing persistent heel pain should consult a medical professional to determine the cause and appropriate treatment plan.