Sever’s Disease - The Most Common Cause of Heel Pain in Children Aged 8-15

Joseph Smith - Physiotherapist

Heel pain is a common complaint in active children and adolescents, particularly during periods of rapid growth. While it can be worrying for both parents and young athletes, one of the most frequent causes is Sever's Disease (calcaneal apophysitis). Although painful, it's a temporary and manageable condition. In this blog, we'll explain what Sever's Disease is, why it develops, and the best ways to manage it so children can return to the activities they love.

What is Sever’s Disease?

Sever's Disease is an irritation of the growth plate at the back of the heel bone, known as the calcaneal apophysis. Growth plates are areas of developing cartilage that allow bones to grow during childhood and adolescence. Because they are softer than mature bone, they are more susceptible to stress from running, jumping and other high-impact activities.

When repeated loading places more stress on the heel than the growth plate can tolerate, it can become irritated, leading to pain and inflammation. Despite its name, Sever's Disease isn't actually a disease or a long-term injury. It's a common, self-limiting condition that only affects growing children. As the growth plates mature and fuse after puberty, the condition resolves permanently.

Who is at risk, and when?

• Active children and teens: Especially those involved in running and jumping sports like soccer, basketball, and gymnastics.

• Growing children/teens: Especially during growth spurts, when the bones grow faster than muscles and tendons can keep up with.

• Ages 8-15: This is the prime age group before the growth plates close.

• Other risk factors:

  • Tight calf muscles (heel cord tightness)

  • Obesity

  • Running on hard surfaces

  • Worn-out or poorly cushioned shoes

Signs and Symptoms

• Pain in one or both heels (it can affect one side or both).

• Pain that gets worse during or after physical activity.

• A noticeable limp, especially after sports.

• Positive Squeeze test: Heel pain when the back or sides of the heel are squeezed.

• Standing on tiptoes makes the pain worse.

Treatment

Sever’s Disease is known as a self-limiting condition, meaning it resolves on its own as the child grows. However, there are ways to manage the pain and help children stay active while healing:

Rest and Reduce Activity: Avoid high-impact sports and activities that worsen the pain.

Pain Relief: Use ice packs (cryotherapy) to reduce inflammation after activity. Over-the-counter pain relievers, like ibuprofen, may help if needed.

Supportive Footwear:

Use silicone heel cups or pads to cushion the heel and reduce stress. Properly fitted shoes with good arch support are essential.

Calf and foot mobility & myo-fascial release: Stretching, mobilising, and release muscle tension and planta fascia, to reduce strain on the growth plate.

Orthotics: Custom-made shoe inserts can correct foot alignment issues if needed.

Key Takeaway

Sever’s Disease is temporary and does not cause long-term damage. Most children recover fully once their growth plates harden during adolescence. Encouraging proper footwear, stretching, and rest can speed up the recovery process and prevent future flare-ups.

If your child is complaining of heel pain, especially after sports, it’s worth checking for Sever’s Disease. While the condition is painful, it’s manageable and temporary. With proper care and support, your young athlete will be back on their feet in no time!

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