SLR - November 2023 - Chowdhury
Title: Incidence of calcaneal apophysitis (Sever's disease) and return-to-play in adolescent athletes of a German youth soccer academy: a retrospective study of 10 yearsReference: Belikan P, Färber LC, Abel F, Nowak TE, Drees P, Mattyasovszky SG. Incidence of calcaneal apophysitis (Sever's disease) and return-to-play in adolescent athletes of a German youth soccer academy: a retrospective study of 10 years. J Orthop Surg Res. 2022 Feb 9;17(1) :83. Doi: 10.1186/s13018-022-02979-9. PMID: 35139872; PMCID: PMC8827183.
Level of Evidence: 3
Reviewed By: Raffin Chowdhury, DPM, MS
Residency Program: Long Island Jewish Forest Hills Queens, NY
Podiatric Relevance: The most common cause of posterior heel pain in a pediatric population (especially between age 10-13) is calcaneal apophysitis also known as sever's disease. This spontaneous heel pain results from injury to the heel bone's growth plate which is caused by overuse rather than specific injury or trauma. This condition is often seen in young athletic children, however is not only limited to them. Podiatric physicians play a significant role in the treatment of Sever's disease as they are specialized in diagnosing, managing, and providing guidance on this condition for young patients experiencing pain and discomfort. This study investigates the risk factors that can lead to calcaneal apophysitis and loss of time until return to play of young professional soccer players dealing with the disease.
Methods: A Level Ill retrospective case series was performed on 612 male soccer players from a professional German youth soccer academy in the years of 2009-2018. A total of 4326 injury cases were manually scanned for calcaneal apophysitis from ages 9-17 were included in this study. All included cases diagnosis was made by team physicians with squeeze test, evaluation of foot biomechanics (including abnormalities of flatfoot and hyperpronation) and body mass index. Follow up visits were performed every 1-3 weeks.
Results: 22 cases of calcaneal apophysitis were detected in 19 athletes over a 10 year period.The mean age of the affected athletes at the time of diagnosis was 11.8 +/- 2.1 years (MW ‡ SD). Bilateral apophysitis was seen in two out of the 19 patients, the rest were unilateral. The incidence of calcaneal apophysitis per 100 athletes per year was found to be 0.36. The mean time to return-to-play of the affected athletes was 60.7 ‡ 64.9 days (MW ‡SD) Three of the 22 detected cases of calcaneal apophysitis (13.6%) were recurrent injuries. Athletes with recurrent complaints showed longer recovery time and time to return-to-play when compared to players with primary diagnosed disease. The mean time to return-to-play of the affected athletes was 60.7 ‡-64.9 days (MW ‡SD). The return to play was longer in patients suffering from bilateral apophysitis compared to unilaterally affected athletes (209.5 vs. 45.9 days).The studies did not find a correlation that age or body mass index at the time of diagnosis had an impact on time to return-to-play.
Conclusion: Calcaneal apophysitis is the most common cause of heel pain in childhood and adolescence, not only seen in youth soccer athletes. This injury accounts for 8% of all pediatric overuse injuries. This study showed that there are several risk factors that may increase duration of return to play such as increased in athletic activity, bilateral or recurrent diagnosis of calcaneal apophysitis. This study provides information to athletes and podiatric physicians.