Non-Operative — Calcaneal Apophysitis (Sever's Disease) — Pediatric

Massachusetts General Hospital · MGH Brigham Pediatric Sports Medicine

Weight-Bearing

Avoid pain-triggering WB activities; heel cup/cushion/lift; WBAT pain-free

Key Restrictions

Activity modification with heel cup, heel cushion, or heel lift; avoid impact activities through Phase III; criteria to discharge: 95% LSI quad/HS/glut med HHD and hop testing >=95% contralateral side

Timeline & Phases

Phase I (0-2 wks): pain/swelling control, ankle AROM, NWB hip strengthening, UBE; Phase II (3-6 wks): WB strengthening, bilateral heel raises, resisted ankle 4-way, supportive footwear/orthotics; Phase III (7-12 wks): eccentric calf loading, bilateral to unilateral heel raises, beginner plyometrics (bilateral then unilateral hopping); Phase IV (3-5 mo): return-to-run interval program, sport-specific agility/plyometrics

Notes

Revised 7/2024; pediatric protocol for calcaneal apophysitis; Phase III criteria: 25 SL heel raises pain-free, 80% LSI strength HHD; discharge criteria: 95% LSI strength and hop testing; criterion-based. [Archived copy — original Massachusetts General Hospital URL retired in the Mass General Brigham site migration; Wayback snapshot 2025-02-16.]

Surgeon / Author

MGH Brigham Pediatric Sports Medicine

Published

2024-07