The point at which a tendon inserts into a bone in a growing child is called an apophysis. This is an area of cartilage and can become inflamed if excessive stress is exerted upon it by the attached tendon. This will be more likely if the muscle and tendon becomes tight as during periods of rapid growth, particularly in athletic individuals. This inflammation, or apophysitis can occur in several areas but is particularly common in the heel (Severs disease) and the knee (Osgood Schlatters).
The Achilles tendon inserts into the calcaneum (heel bone). Patients with Severs disease experience discomfort at the point of insertion of the tendon into the bone. Classically this occurs in teenagers but can occur as young as 9 or 10 years. Pain tends to occurs during and after exercise. Initially the symptoms will settle rapidly with rest but become more persistant if ignored.
When examined patients complain of discomfort when the calcaneum is palpated and there may be associated tightness of the Achilles tendon and calf. Specialist investigations are usually not necessary although fragmentation and sclerosis of the apophysis are often evident on plain radiographs.