There are several causes of heel pain in the young athletic population with the most common being calcaneal apophysitis (also referred to as Sever’s disease). Sever first reported calcaneal apophysitis in 1912 as an inflammation of the apophysis, causing discomfort to the heel, mild swelling and difficulty walking in growing children.1

   

The condition usually manifests between the ages of 8 and 14 with a higher incidence in boys than girls. In reality, however, calcaneal apophysitis is being diagnosed more frequently in girls due to their increase in participating in sports such as soccer, basketball and Netball. There are many biomechanical factors that predispose a young athlete to calcaneal apophysitis. The majority of patients will present with an ankle equinus deformity (compromise of ankle motion), which ultimately exerts an increased pulling force to the Achilles insertion and non-ossified apophysis. Furthermore, patients may present with hyperpronation of the rearfoot. This allows more of a lack of motion control on the frontal plane of the calcaneus. Treatment goals should focus on improving these biomechanical factors while the young athlete is undergoing skeletal maturation.