Possible association between Sever's disease and attention deficit hyperactivity disorder. a prospective observational study

Background: Sever's disease is among the most common causes of foot pain in childhood.The etiology of Sever's disease is still under debate.The objective of this prospective study is to investigate the relationship between Sever's disease and attention deficit hyperactivity disorder(ADHD).

Methods: The study was prospectively conducted for 1 year between 2023-2024.Of 238 children admitted to our clinic with foot pain, 88 children diagnosed with Sever's disease were included in the study.A control group including 90 individuals was employed.Patients diagnosed with Sever's disease in the orthopedics outpatient clinic and healthy control group were evaluated by a pediatric psychiatrist in terms of ADHD based on the DSM-4 diagnostic criteria.

Results: Fifty-seven patients were male, and 31 were female.While 45 male patients were diagnosed with ADHD, 12 of them did not have ADHD.While 17 female patients were diagnosed with ADHD, 14 did not have ADHD. ADHD was detected in 12 (13.3%) of 90 patients in the control group, comprising 9 boys and 3 girls. The prevalence of ADHD in the Sever's disease cohort was 62 (70.5%) out of 88, significantly higher than the control group's 12 (13.3%) out of 90 patients (p < 0.01). The high number of the patients diagnosed with ADHD among the Sever's patients who were not engaged in sports was found to be statistically significant(p < 0.01).The diagnosis of ADHD was found to be statistically more significant in boys with Sever's disease compared to girls(p < 0.018).

Conclusion: Children with Sever's disease can be the candidates for attention deficit hyperactivity disorder.It is thought that evaluating children, especially male children, diagnosed with calcaneal apophysitis within the framework of attention deficit hyperactivity disorder will be valuable.