Sever's Disease


Sever’s disease, also known as calcaneal apophysitis, is a common cause of heel pain in growing children, particularly physically active children.

This condition is not an actual disease but rather an overuse injury when the growth plate (a soft area of developing tissue at the end of a long bone) in the heel becomes inflamed.

What is Sever’s Disease? Common Cause of Heel Pain in Children

In growing children, Sever’s disease involves inflammation of the growth plate (apophysis) on the back and bottom of the heel bone (calcaneus).

  • Common cause of pain in the heel in ages 8 to 15 years old
  • Related to repetitive stress on the heel during activity
  • Pain worsens with running and jumping
  • Resolves once the growth plate fuses after puberty
  • Treatments include rest, orthotics, physical therapy, anti-inflammatories

Understanding Sever’s helps recognize and manage this common pediatric heel condition.

Symptoms of Sever’s Disease

sever's disease is a common cause of heel pain
Photo Credit: gpointstudio

Few symptoms of Sever’s Disease are as follows:

  • Pain and tenderness at the back or bottom of the heel during or after activity
  • Limping or altered gait from heel discomfort
  • Difficulty participating in sports due to heel pain
  • Swelling, redness or bruising of the painful heel area
  • Feeling unsteady during movements like hopping due to heel pain
  • Heel tightness or decreased range of motion

Symptoms are typically only present during or after exercise, unlike in Achilles tendinitis or plantar fasciitis. The pain subsides once the growth plate finishes maturing.

What Causes Sever’s Disease? Inflammation of the Growth Plate of the Heel Bone

Sever’s disease most commonly occurs during the growth spurt of adolescence, around the ages of 8 to 15 for girls and 10 to 17 for boys. During this time, the heel bone (calcaneus) can grow faster than the muscles, tendons, and ligaments in the leg, which can cause them to become tight and overstretched. This can put too much stress on the heel’s growth plate and lead to inflammation and pain – a condition known as Sever’s disease.

Factors that can increase a child’s risk of developing Sever’s disease include:

  • Stress on the heel’s growth plate from repetitive impact and pull of the Achilles tendon
  • Tight calf muscles and Achilles tendon adding excessive pull on the growth plate
  • Rapid growth spurts in adolescence put increased demands on the heels
  • Running, jumping, and athletic activities that overload the heel bone
  • Inflexible or poorly biomechanically aligned feet
  • Being overweight increases stress on the growth plates
  • Overuse and too much high-impact activity too soon

Sudden increases in activity levels and sports participation make the disease more likely to occur.

Risk Factors for Sever Disease

Sever's disease is commonly seen in teenagers with hyperactive lifestyles
Photo Credit: Freepik

Some of the risk facts of sever’s disease are as follows;

  • Childhood and early adolescence during growth spurts
  • Participation in sports with running and jumping – football, basketball, gymnastics, ballet
  • Higher weight or obesity
  • Tight muscles of calf or reduced ankle flexibility
  • Excessive foot pronation or high foot arches
  • Starting a new sport or increasing training intensity suddenly
  • Wearing worn-out athletic shoes with poor shock absorption

These modifiable factors help identify which young athletes are most at risk for developing Sever’s.

How is Sever’s Disease Diagnosed?

Sever’s disease can be diagnosed through:

  • Medical history – Age, sports activities, recent spurts
  • Physical exam – Pressing along the back and underside of the heel for pain
  • Foot assessment – Alignment, flexibility and biomechanical abnormalities
  • Ultrasound – Can show inflammation of the calcaneal growth plate
  • X-ray – To rule out heel bone fracture if the trauma occurred

There are no definitive diagnostic tests. Diagnosis is based on typical symptoms plus age and activity history.

Sever’s Disease Treatment Approach

In most cases, Sever’s disease resolves on its own once the child’s rapid growth ends. However, managing symptoms effectively is essential to prevent any interruption in the child’s ability to participate in physical activities. If your child is experiencing heel pain, consult a healthcare professional for a proper evaluation and treatment plan.

Sever's disease pain can be alleviated with the help of ibuprofen and other over the counter medicines
Photo Credit: jcomp

Treatment focuses on reducing stress on the irritated growth plate to allow it to heal:

Immediate Management

  • Rest from aggravating activities, especially high-impact sports
  • Ice the heel for 15 minutes a few times per day to decrease inflammation
  • Over-the-counter anti-inflammatory medication like ibuprofen

Rehabilitation Exercises

  • Calf muscle stretches and strengthening exercises
  • Physical therapy modalities as needed like ultrasound

Orthotics and Footwear Modifications

  • Shock-absorbing heel cups or pads
  • Insert orthotics to improve foot alignment
  • Properly fitted sport shoes with good cushioning
  • Short term cast or walking boot for severe cases

Recovery Timeframe

  • Symptoms typically resolve within 6 to 12 months as the growth plate finishes developing.
  • Activity modification and stretching helps prevent a recurrence

With compliance and rest from aggravating activities, Sever’s disease generally resolves fully in growing kids. Surgery is never needed.

Prevention Strategies to Reduce the Risk of Sever’s

sever's disease can be managed with the help of heel exercises
Photo Credit: Racool_studio

Methods to help prevent Sever’s disease:

  • Perform calf and Achilles stretches before/after exercise
  • Start sports slowly and build up gradually
  • Use orthotics for poor foot biomechanics
  • Wear proper supportive athletic shoes
  • Take breaks from running sports and substitute cross-training
  • Maintain a healthy weight to avoid overloading feet

Being proactive and limiting high-impact sports helps prevent recurrence.

Long-Term Outlook for Sever’s Disease

Sever’s disease itself does not cause any long-term damage or complications with proper management. Symptoms disappear once the growth plates ossify, and the heel bone matures during adolescence.

Achilles tendinitis, plantar fasciitis or heel spurs may develop later in life if predisposing foot alignment issues occur. Maintaining good flexibility, strength, and foot mechanics helps prevent heel pain as adults. Sever’s disease does not recur after skeletal maturity is reached.


What triggers Sever’s disease?

Sever’s disease is often triggered by repetitive stress from sports involving running and jumping during rapid growth in childhood and adolescence. Tight calf muscles and poorly aligned feet can also contribute.

How long does it take for Sever’s disease to go away?

Sever’s disease symptoms typically resolve within 6 to 12 months with proper treatment as the growth plate finishes maturing. Modifying activities helps speed recovery.

Can my child still play sports with Sever’s disease?

Sports aggravating heel pain should be avoided until Sever’s disease resolves to prevent recurrence. Low-impact activities or substituting swimming/cycling for running sports can allow participation.

How do you treat Sever’s disease in children?

Sever’s disease is treated with rest, anti-inflammatories, ice, orthotics, heel pads, calf stretching, footwear modifications, and activity limitations until the growth plate finishes developing. Physical therapy also helps.

What is Sever Disease?

Sever disease, also known as calcaneal apophysitis, is a common cause of pain in the heel in children. It occurs when there is inflammation in the growth plate of the heel bone.

What are the symptoms of Sever Disease?

The most common symptom of Sever Disease is heel pain, especially in the back of the heel. The pain may be worse during activities that involve running or jumping.

What causes Sever Disease?

The exact cause of Sever Disease is still unknown. However, it is believed to be caused by the stress placed on the heel’s growth plate due to activities like running or jumping on hard surfaces.

How is Sever Disease diagnosed?

Diagnosis of Sever Disease is usually based on a physical examination by a podiatrist or another health professional. Sometimes, an X-ray may be taken to rule out other possible causes of pain in the heel.

What is the treatment for Sever Disease?

The treatment for Sever Disease involves reducing the stress placed on the heel. This may include rest, heel lifts or inserts, and supportive shoes. Physical therapy exercises may also be recommended to strengthen the calf muscles and tendons.

How long does Sever Disease last?

Sever Disease is a self-limiting condition, which means it usually resolves on its own once the growth plate in the heel has closed. The state typically lasts for a few months to a year but can vary in duration.