• 1

    Saperstein AL, Nicholas SJ: Pediatric and adolescent sports medicine. .Pediatr Clin North Am 43::1013. ,1996. .

  • 2

    Sever JW: Apophysitis of the os calcis. .N Y Med J 95::1025. ,1912. .

  • 3

    Ogden JA, Ganey TM, Hill JJ, et al: Sever’s injury: a stress fracture of the immature calcaneal metaphysis. .J Pediatr Orthop 24::488. ,2004. .

  • 4

    Peck DM: Apophyseal injuries in the young athlete. .Am Fam Physician 51::1891. ,1995. .

  • 5

    Kvist MH, Heinonen OJ: Calcaneal apophysitis (Sever’s disease): a common cause of heel pain in young athletes. .Scand J Med Sci Sports 1::235. ,1991. .

  • 6

    Kim CW, Shea K, Chambers HG: Heel pain in children: diagnosis and treatment. .JAPMA 89::67. ,1999. .

  • 7

    Madden CC, Mellion MB: Sever’s disease and other causes of heel pain in adolescents. .Am Fam Physician 54::1995. ,1996. .

  • 8

    Micheli LJ, Ireland ML: Prevention and management of calcaneal apophysitis in children: an overuse syndrome. .J Pediatr Orthop 7::34. ,1987. .

  • 9

    Wirtz PD, Vito GR, Long DH: Calcaneal apophysitis (Sever’s disease) associated with tae kwon do injuries. .JAPMA 78::474. ,1988. .

  • 10

    McKenzie DC, Taunton JE, Clement DB, et al: Calcaneal epiphysitis in adolescent athletes. .Can J Appl Sport Sci 6::123. ,1981. .

  • 11

    Ishikawa SN: Conditions of the calcaneus in skeletally immature patients. .Foot Ankle Clin 10::503. ,2005. .

  • 12

    Orava S, Puranen J: Exertion injuries in adolescent athletes. .Br J Sports Med 12::4. ,1978. .

  • 13

    Orava S, Virtanen K: Osteochondroses in athletes. .Br J Sports Med 16::161. ,1982. .

  • 14

    Hendrix CL: Calcaneal apophysitis (Sever disease). .Clin Podiatr Med Surg 22::55. ,2005. .

  • 15

    Rome K: Anthropometric and biomechanical risk factors in the development of plantar heel pain: a review of the literature. .Phys Ther Rev 3::123. ,1997. .

  • 16

    Adirim TA, Cheng TL: Overview of injuries in the young athlete. .Sports Med 33::75. ,2003. .

  • 17

    Clain MR, Hershman EB: Overuse injuries in children and adolescents. .Phys Sportsmed 17::111. ,1989. .

  • 18

    Micheli LJ, Fehlandt AF Jr: Overuse injuries to tendons and apophyses in children and adolescents. .Clin Sports Med 11::713. ,1992. .

  • 19

    Szames SE, Forman WM, Oster J, et al: Sever’s disease and its relationship to equinus: a statistical analysis. .Clin Podiatr Med Surg 7::377. ,1990. .

  • 20

    Kaeding CC, Whitehead R: Musculoskeletal injuries in adolescents. .Prim Care 25::211. ,1998. .

  • 21

    Haglund P: Concerning some rare but important surgical injuries brought on by violent exercise. .Lancet 172::12. ,1908. .

  • 22

    Meyerding HW, Stuck WG: Painful heels among children [apophysitis]. .JAMA 102::1658. ,1934. .

  • 23

    Crawford AH, Gabriel KR: Foot and ankle problems. .Orthop Clin North Am 18::649. ,1987. .

  • 24

    Omey ML, Micheli LJ: Foot and ankle problems in the young athlete. .Med Sci Sports Exerc 31::S470. ,1999. .

  • 25

    Hetherington BH: Sever’s disease: traction apophysitis of calcaneum [in correspondence]. .N Z J Sports Med 13::58. ,1985. .

  • 26

    Santopietro FJ: Foot and foot-related injuries in the young athlete. .Clin Sports Med 7::563. ,1988. .

  • 27

    Bartold S: Heel pain in young athletes. .Aust Podiatrist 27::103. ,1993. .

  • 28

    Harding VV: Time schedule for the appearance and fusion of a second accessory center of ossification of the calcaneus. .Child Dev 23::181. ,1952. .

  • 29

    Hoerr NL, Pyle SI, Francis CC: Radiographic Atlas of Skeletal Development of the Foot and Ankle, CC Thomas, Springfield, IL. ,1962. .

    • PubMed
    • Export Citation
  • 30

    Shopfner CE, Coin CG: Effect of weight-bearing on the appearance and development of the secondary calcaneal apophysis. .Radiology 86::201. ,1966. .

  • 31

    Liberson A, Lieberson S, Mendes DG, et al: Remodeling of the calcaneus apophysis in the growing child. .J Pediatr Orthop B 4::74. ,1995. .

  • 32

    Krantz MK: Calcaneal apophysitis: a clinical and roentgenologic study. .JAPA 55::801. ,1965. .

  • 33

    Katz JF: Nonarticular osteochondroses. .Clin Orthop Relat Res 158::70. ,1981. .

  • 34

    Brantigan CO: Calcaneal apophysitis. .Rocky Mt Med J 69::59. ,1972. .

  • 35

    Webster B: Prevention and treatment of injuries in young athletes. .Athletics Coach 17::31. ,1983. .

  • 36

    Micheli LJ, Fehlandt AF: Overuse tendon injuries in pediatric sports medicine. .Sports Med Arthroscopy Rev 4::190. ,1996. .

  • 37

    McCrea JD: Pediatric Orthopedics of the Lower Extremity, Futura, Mount Kisco, NY. ,1985. .

    • PubMed
    • Export Citation
  • 38

    Hauser EDW: Diseases of the Foot, WB Saunders, Philadelphia. ,1939. .

  • 39

    Dalgleish M: Calcaneal apophysitis [Sever’s disease] clinically based treatment. Sportsmed News (June): 15. ,1990. .

    • PubMed
    • Export Citation
  • 40

    Subotnik SJ (ED): Sports Medicine of the Lower Extremity, Churchill-Livingstone, New York. ,1989. .

    • PubMed
    • Export Citation
  • 41

    Gregg JR, Das M: Foot and ankle problems in the preadolescent and adolescent athlete. .Clin Sports Med 1::131. ,1982. .

  • 42

    Stess RM: Persistent calcaneal apophysitis. .JAPA 63::147. ,1973. .

  • 43

    Garbett L: Calcaneal apophysitis: Sever’s disease. Sportsmed News (December): 9. ,1991. .

    • PubMed
    • Export Citation
  • 44

    Bruns W, Maffulli N: Lower limb injuries in children in sports. .Clin Sports Med 19::637. ,2000. .

  • 45

    Scharfbillig RW, Jones S, Scutter SD: Sever’s disease: what does the literature really tell us?. JAPMA 98::212. ,2008. .

  • 46

    Lamm BM, Paley D, Herzenberg JE: Gastrocnemius soleus recession: a simpler, more limited approach. .JAPMA 95::18. ,2005. .

  • 47

    McCrea JD: Is there really a calcaneal apophysitis?. Foot Leg Function 1::7. ,1989. .

  • 48

    Walling AK, Grogan DP, Carty CT, et al: Fractures of the calcaneal apophysis. .J Orthop Trauma 4::349. ,1990. .

  • 49

    Centers for Disease Control and Prevention. Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion Web site. Available at: http://www.cdc.gov/nccdphp/dnpa/bmi/index.htm. Updated May 22. ,2007. . Accessed March 27, 2008.

    • PubMed
    • Export Citation
  • 50

    Nicholson DE, Armstrong PF, MacWilliams BA, et al: The effects of velocity, step initiation, and a visible platform on plantar pressures of healthy children. .Gait Posture 7::146. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51

    Silfverskiöld N: Reduction of the uncrossed two-joint muscles of the leg to one-joint muscles in spastic conditions. .Acta Chir Scand 56::315. ,1924. .

  • 52

    Downey MS: “Ankle Equinus,” in Comprehensive Textbook of Foot Surgery, 2nd Ed, Vol 1, ed by ED McGlamry, AS Banks, MS Downey, p 687, Williams & Wilkins, Baltimore. ,1992. .

    • PubMed
    • Export Citation
  • 53

    Root ML, Orien WP, Weed JH: Normal and Abnormal Function of the Foot, Spanish edition, Clinical Biomechanics Corp, Los Angeles. ,1977. .

    • PubMed
    • Export Citation
  • 54

    DiGiovanni CW, Kuo R, Tejwani N, et al: Isolated gastrocnemius tightness. .J Bone Joint Surg Am 84::962. ,2002. .

  • 55

    Downey MS, Banks AS: Gastrocnemius recession in the treatment of nonspastic ankle equinus: a retrospective study. .J Am Podiatr Med Assoc 79::159. ,1989. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 56

    Evans AM, Scutter SD: Sagittal plane range of motion of the pediatric ankle joint: a reliability study. .JAPMA 96::418. ,2006. .

  • 57

    Jahss MH, Kummer F, Michelson JD: Investigations into the fat pads of the sole of the foot: heel pressure studies. .Foot Ankle 13::227. ,1992. .

  • 58

    Perry J: Anatomy and biomechanics of the hindfoot. .Clin Orthop 177::9. ,1983. .

  • 59

    Tax HR: Podopediatrics, 2nd Ed, Williams & Wilkins, Baltimore. ,1985. .

  • 60

    Alexander IJ: The Foot, 2nd Ed, Churchill Livingstone, New York. ,1997. .

  • 61

    Topham AE, White JA: Sever’s disease. .Phys Ther Case Rep 1::160. ,1998. .

  • 62

    McGlamry ED, Kitting RW: Equinus foot: an analysis of the etiology, pathology and treatment techniques. .JAPA 63::165. ,1973. .

  • 63

    Knutzen KM, Price A: Lower extremity static and dynamic relationships with rearfoot motion in gait. .JAPMA 84::171. ,1994. .

  • 64

    Nuber GW: Biomechanics of the foot and ankle during gait. .Clin Sports Med 7::1. ,1988. .

  • 65

    Lavery LA, Armstrong DA, Boulton AJM: Ankle equinus deformity and its relationship to high plantar pressure in a large population with diabetes mellitus. .JAPMA 92::479. ,2002. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 66

    Wrobel JS, Connolly JE, Beach ML: Associations between static and functional measures of joint function in the foot and ankle. .JAPMA 94::535. ,2004. .

  • 67

    Winter DA: Kinematic and kinetic patterns in human gait: variability and compensating effects. .Human Mov Sci 3::51. ,1984. .

  • 68

    Brodersen A, Pedersen B, Reimers J: Foot deformities and relation to the length of leg muscles in Danish children aged 3–17 years. .Ugeskr Laeger 155::3914. ,1993. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 69

    Baum I, Spencer AM: Limb dominance: its relationship to foot length. .JAPMA 70::505. ,1980. .

  • 70

    Herring KM: Injury prediction among runners: preliminary report on limb dominance. .JAPMA 83::523. ,1993. .

  • 71

    Montague JR, Bovarnick M, Effren SC, et al: The demography of limb dominance, body-mass index, and metatarsus adductus deformity. .JAPMA 88::429. ,1998. .

Plantar Pressures in Children With and Without Sever’s Disease

Ricardo Becerro de Bengoa Vallejo Escuela Universitaria Enfermeria, Fisioterapia y Podologia, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.

Search for other papers by Ricardo Becerro de Bengoa Vallejo in
Current site
Google Scholar
Marta Elena Losa Iglesias Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain.

Search for other papers by Marta Elena Losa Iglesias in
Current site
Google Scholar
David Rodríguez Sanz Soccer Club Atlético de Madrid, Madrid, Spain.

Search for other papers by David Rodríguez Sanz in
Current site
Google Scholar
Juan Carlos Prados Frutos Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.

Search for other papers by Juan Carlos Prados Frutos in
Current site
Google Scholar
 MD, PhD
Paloma Salvadores Fuentes Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain.

Search for other papers by Paloma Salvadores Fuentes in
Current site
Google Scholar
, and
José López Chicharro Escuela Universitaria Enfermeria, Fisioterapia y Podologia, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.

Search for other papers by José López Chicharro in
Current site
Google Scholar
 MD, PhD

Background: A case-control study was conducted to compare static plantar pressures and distribution of body weight across the two lower limbs, as well as the prevalence of gastrocnemius soleus equinus, in children with and without calcaneal apophysitis (Sever’s disease).

Methods: The participants were 54 boys enrolled in a soccer academy, of which eight were lost to follow-up. Twenty-two boys with unilateral Sever’s disease comprised the Sever’s disease group and 24 healthy boys constituted a control group. Plantar pressure data were collected using pedobarography, and gastrocnemius soleus equinus was assessed.

Results: Peak pressure and percentage of body weight supported were significantly higher in the symptomatic feet of the Sever’s disease group than in the asymptomatic feet of the Sever’s disease group and the control group. Every child in the Sever’s disease group had bilateral gastrocnemius equinus, while nearly all children in the control group had no equinus.

Conclusions: High plantar foot pressures are associated with Sever’s disease, although it is unclear whether they are a predisposing factor or a result of the condition. Gastrocnemius equinus may be a predisposing factor for Sever’s disease. Further research is needed to identify other factors involved in the disease and to better understand the factors that contribute to abnormal distribution of body weight in the lower limbs. (J Am Podiatr Med Assoc 101(1): 17–24, 2011)

Corresponding author: Ricardo Becerro de Bengoa Vallejo, DPM, PhD, Escuela Universitaria Enfermeria, Fisioterapia y Podologia, Facultad de Medicina, Universidad Complutense de Madrid, Avenida Complutense s/n, Madrid, 28040 Spain. (E-mail: ribebeva@enf.ucm.es)