Sever’s disease is a common cause of heel pain in active children, especially during growth spurts and busy sport periods. It usually affects children who do frequent running and jumping, and it often becomes more noticeable after training, games, or PE classes. It is also one of the more common kids sports injuries seen during rapid growth. For a broader overview of similar problems, visit our heel pain guide.

Sever’s disease is a growth-related heel condition in children where repetitive stress irritates the growth plate at the back of the heel bone (calcaneus), often causing pain during running or jumping sports.

The calf muscles attach to the heel through the Achilles tendon. During rapid growth, bones can grow faster than muscles and tendons adapt, which may increase tension through the heel. In many children, symptoms settle well with sensible load management, supportive footwear, and physiotherapy guidance.

Symptoms of Sever’s Disease

Children with Sever’s disease commonly experience heel pain during or after physical activity. The pain usually occurs at the back or underside of the heel where the growth plate sits.

• Heel pain during or after running or jumping
• Limping or walking awkwardly
• Pain when rising onto tiptoes
• Tenderness when squeezing the sides of the heel
• Heel stiffness after sport or activity

Symptoms often ease with rest but can return when activity levels rise again.

What is Sever’s Disease?

Sever’s disease, also called calcaneal apophysitis, is an overuse injury affecting the heel growth plate in growing children. Despite the name, it is not an infection or a serious disease process. Instead, it is a common irritation of a developing part of the heel bone caused by repeated pulling and loading.

It is most often seen in active children during early adolescence.

• Girls: often between 8 and 10 years
• Boys: commonly between 10 and 12 years

Is Sever’s Disease Serious?

Although the name can sound worrying, Sever’s disease is usually a temporary growth-related condition. It does not usually cause permanent heel damage, and most children improve once the irritated growth plate settles and later matures.

The main issue is pain during activity. With sensible management such as modifying sport, improving calf flexibility, supporting the heel, and addressing footwear or foot mechanics, most children return to normal activity well.

What Causes Sever’s Disease?

Sever’s disease develops when repeated forces through the heel irritate the growth plate. This is more likely during growth spurts, particularly in children who train often or play high-impact sport.

• Running injuries and jumping sports
• Rapid growth phases
• Tight calf muscles
• Hard playing surfaces
• Poorly fitting or worn footwear
• Foot posture or biomechanical changes
• Higher training loads
• Higher body weight

Foot and ankle mechanics can also contribute. Problems with the foot, the ankle, or the way the lower limb absorbs force may increase load through the heel.

Diagnosis

A physiotherapist can usually diagnose Sever’s disease through a detailed assessment. This normally includes your child’s history, sport load, growth pattern, walking and running mechanics, calf flexibility, and local tenderness around the heel. A commonly used clinical test is the heel squeeze test.

Imaging is not usually required unless another diagnosis is suspected. A current clinical overview also notes that calcaneal apophysitis is a common overuse condition in young athletes and is usually diagnosed clinically rather than through routine imaging (NCBI clinical overview).

Other Causes of Heel Pain in Children

Although Sever’s disease is one of the most common causes of heel pain in active children, it is not the only possible source. A physiotherapist may also assess for:

• Plantar fasciitis
• Retrocalcaneal bursitis
• Achilles tendon irritation
• Heel bone stress injury
• Foot or ankle biomechanical problems

A proper clinical assessment helps confirm the diagnosis and guide the right management plan.

How Is Sever’s Disease Treated?

Most children recover from Sever’s disease with conservative treatment. Management usually focuses on reducing stress on the heel growth plate while the irritation settles.

• Temporarily reducing running and jumping activities
• Calf stretching and ankle mobility exercises
• Foot and lower leg strengthening exercises
• Shock-absorbing heel cups or heel lifts
• Supportive footwear
• Sports taping in some cases
• Gradual return to sport once symptoms improve

Clinical research suggests that temporary activity modification is one of the most effective early strategies. The condition is also considered self-limiting, which means it usually settles as the heel growth plate matures.

Physiotherapy Treatment for Sever’s Disease

1. Activity Modification

The first step is usually reducing painful running, jumping, and repeated high-impact loading. Complete rest is not always necessary, but symptoms should guide how much activity your child does.

2. Calf Flexibility and Ankle Mobility

Tight calf muscles are commonly associated with Sever’s disease because the Achilles tendon attaches close to the irritated growth plate. Physiotherapy often includes calf stretching and ankle mobility work to reduce tension through the heel.

3. Strength and Foot Control

Strengthening the foot arch and lower leg muscles may help improve load absorption and foot control. Exercises such as active foot posture correction exercises may be useful when foot posture contributes to symptoms.

4. Heel Cups and Orthotics

Shock-absorbing heel cups or heel lifts may reduce tension through the Achilles tendon and reduce impact through the heel during sport. You can read more about heel cups, supportive products such as Tuli’s Heel Cups, and orthotics.

5. Biomechanical Assessment

If poor foot posture, altered running mechanics, or repeated overload are contributing factors, a biomechanical assessment may help identify what needs to change.

6. Taping Techniques

Sports taping may help reduce strain on the heel during activity. Physiotherapists sometimes use taping as a short-term support strategy while symptoms settle, particularly when a child is returning to modified sport.

7. Gradual Return to Sport

Children usually return to full sport once heel pain settles and calf strength, flexibility, and load tolerance improve. A gradual progression is usually better than an immediate return to full training.

Can Children Continue Sport with Sever’s Disease?

Many children can continue some sport, but training usually needs to be modified. If running, jumping, or sprinting clearly increases heel pain, it often helps to reduce those activities for a short period and keep other exercise that does not aggravate symptoms. This is particularly relevant in sports linked to jumping injuries, where repeated landing loads can irritate the heel further.

This approach often helps children stay active without repeatedly flaring the heel.

Advice for Parents

If your child develops heel pain during sport, it is worth taking the symptoms seriously. While Sever’s disease is common during growth spurts, continuing intense activity despite pain can prolong recovery.

• Reduce high-impact sport temporarily if pain is building
• Encourage calf stretching after activity
• Check that footwear is still supportive and fits well
• Use shock-absorbing heel support if recommended
• Monitor symptoms closely during growth spurts

If heel pain persists or starts affecting walking, a physiotherapist can assess the condition and recommend a clear plan.

Can Sever’s Disease Be Prevented?

You cannot prevent growth spurts, but you may reduce the risk of flare-ups by managing training loads and supporting the heel well during busy sport periods.

• Maintain good calf flexibility
• Increase sport load gradually
• Use supportive, well-fitting footwear
• Address foot posture concerns early
• Review training surfaces and total weekly load

Related Heel Conditions

Not all heel pain is caused by Sever’s disease. Depending on age, location of pain, and activity pattern, your physiotherapist may also assess for:

• Plantar fasciitis
• Heel spur
• Achilles tendinopathy
• Heel pain

When Should You Seek Professional Advice?

Most cases of Sever’s disease improve with simple activity modification and physiotherapy management. However, professional advice may be helpful if:

• Heel pain persists for more than a few weeks
• Your child starts limping or avoids weight-bearing
• Pain interferes with sport or daily activity
• Symptoms occur without sport or seem unusually severe

A physiotherapist can assess heel pain, confirm the diagnosis, and guide a safe return to activity.

What to Do Next

If your child has ongoing heel pain during sport, an assessment may help confirm whether it is Sever’s disease and identify what is driving the irritation. Early management often helps children stay active while reducing the risk of repeated flare-ups.

References

• Fares MY, Salhab HA, Khachfe HH, et al. Sever’s Disease of the Pediatric Population: Clinical, Pathologic, and Therapeutic Considerations. Cureus. 2021;13(8):e17319.
• Kothari EA, Padilla JA, McCulloch PC. A Review of Pediatric Heel Pain. Cureus. 2023;15(2):e35216.
• Hernandez-Lucas P, Hidalgo-Garcia C, Lopez-de-Uralde-Villanueva I, et al. Conservative Treatment of Sever’s Disease: A Systematic Review. Int J Environ Res Public Health. 2024;21(4):442.