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Osgood-Schlatter’s and Sever’s Disease

Traction Apophysitis

Traction apophysitis is a painful inflammatory condition of a normal bony protrusion that typically presents in active adolescents. As we mature, growth plates (epiphyseal plates) in our bones develop at much faster rates than our muscles and tendons. This mis-match leads to a slower lengthening process for muscle and tendon compared to bone.

The result is the potential to cause strong traction, or pulling, forces exerted on the areas where the muscle’s tendon attaches to these bony prominences. This produces irritation, inflammation, pain, and if left untreated may cause small parts of bone to be pulled away (called an avulsion fracture).

This situation is especially amplified during repetitive or high-load activities, such as those sports involving running, jumping, and landing. 

The most common sites of traction apophysitis are just below the knee (known as Osgood-Schlatter’s) and at the back of the heel (known as Sever’s condition).


The quadriceps lie at the front of the thigh and are powerful knee extensors. These muscles converge to share a common tendon (the patella tendon) which attaches to the bony protrusion just below the knee known as the tibial tuberosity.

When we extend our knee, the quadriceps contract and the patella tendon acts as an anchor against the tibial tuberosity. However, traction apophysitis can occur if the anchor is too strong, and the tendon begins to pull at the bone.

Children with Osgood-Schlatter’s will likely report localised pain to the tibial tuberosity (either in one or both legs), especially during physical activity, and the knee may appear swollen and/or enlarged due to bony remodelling in response to the associated micro-trauma.

Sever’s Condition

The muscles comprising the calf are similar to the quadriceps in that they too share a common tendon, the Achilles, which inserts into the back of the heel, slightly towards the inside of the foot.

Running and jumping activities, where the foot is raised and lowered rapidly or with great force or repetition, can place large amounts of stress on the Achilles tendon and its attachment to the heel bone (calcaneus). As with Osgood-Schlatter’s, such forces may produce micro-trauma at the bony insertion site and result in a similar clinical presentation regarding the heel.

Treatment and Management

Traction apophysitis is a self-limiting condition. That is, those with symptoms must acknowledge when they are experiencing pain and make necessary adjustments in order to continue living active and healthy lives.

This often involves:

  • Appropriately modifying activity and load
  • Using ice and medication as prescribed
  • Improving neuromuscular activation and control
  • Addressing biomechanical and/or sporting technique issues
  • Progressively strengthening muscles, tendons, ligaments and bones

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