# Lower Limb Osteochondrosis and Apopbysitis in Young Athletes--A Comprehensive Review
## 5 Sever's Disease: Presentation, Diagnosis, and Management  
Sever's disease (SVD), or calcaneal apophysitis, is a common overuse injury that affects active children and young athletes [64]. It is characterized by inflammation or bone edema that typically results from stress fractures in the secondary ossification center of the calcaneus. This inflammation is caused by repetitive traction forces exerted by the Achilles tendon on the calcaneal apophysis [65]. Figure 3 illustrates two cases of SVD in young athletes. The images show the presence of irregular contours within the cortical layer of the calcaneal tuberosity.  
Figure 3: [PERSON]’s disease on the ultrasound image. Irregular contours of the cortical layer of the calcaneal tuberosity are noted. **(a)** Left calcaneal tuberosity. **(b)** Right calcaneal tuberosity.  
Clinically, SVD typically presents with a gradual onset of pain, which often occurs suddenly and without a preceding traumatic event [66]. The literature indicates that SVD is relatively common, accounting for approximately 2 to 16% of sports clinic consultations and 5.8 to 22.7% of repetitive stress injuries in the pediatric population [67]. Moreover, SVD is considered the leading cause of heel pain in the youth population [64; 65], with higher prevalence in girls aged 7 to 9 years and in boys aged 8 to 15 years and a peak incidence occurring between the ages of 10 and 12 years [65].  
The patient with SVD presents with activity-related pain. Examination reveals local tenderness and swelling at the insertion of the Achilles tendon [64]. A positive heel squeeze test is typically seen on the examination of a patient with SVD [64]. This finding is usually sufficient to suggest SVD. However, radiographic examination may be necessary to rule out other differential diagnoses [66; 68]. In the case of SVD, pain is typically bilateral, and examination reveals limited dorsiflexion and altered foot alignment [65]. Factors that contribute to the development of SVD include a history of OSD [69] and participation in high-intensity sports such as football or basketball [70]. In addition, starting a new sport may also be associated with an increased risk of developing this disease [71].  
Treatment of SVD is primarily conservative and is considered the preferred approach for the management of this condition. The primary goal of interventions is to reduce pain and improve ankle function [71]. Several therapeutic interventions, including physiotherapy [72], orthopedic insoles [73], and kinesiology taping [74], are supported by the scientific literature. Physiotherapy is particularly important. Studies have shown that appropriately tailored stretching and lengthening exercises for the gastrocnemius muscle along with massage therapy can significantly reduce pain and improve ankle function in patients with heel pain [72]. Kinesiology taping has also been shown to improve ankle dorsiflexion [74]. Orthoses, such as insoles and heel cushions, have shown excellent results in scientific studies by effectively alleviating pain and optimizing ankle mobility [75; 76]. They are often considered to be one of the most effective methods of heel pain management [77]. Ice application, activity modification or restriction, rest, and topical NSAIDs have also been found to be helpful in the treatment of SVD [67]. In this condition, the symptoms typically resolve within a few weeks to months, and the disease is generally self-limiting. Surgical intervention is not a component of the management of SVD.