Severs Disease

Severs Disease

Article by J.Miller, M.Hewitt

Sever’s Disease

A Guide for Parents and Caregivers

Sever’s disease, also known as calcaneal apophysitis, is a prevalent cause of heel pain in active children, particularly during their growth spurts. This guide, informed by physiotherapy knowledge, aims to provide comprehensive insights into Sever’s disease, including its causes, symptoms, and effective management strategies.

We’ll also discuss the latest research and provide practical advice for parents and caregivers. Remember, for personalised advice, always consult a professional physiotherapist.

What is Sever’s Disease?

Sever’s disease arises from excessive forces injuring the heel’s growth plate during early adolescence. It’s most common in physically active children undergoing rapid growth phases.

Age of Occurrence

  • Girls: Typically between 8 to 10 years of age.
  • Boys: Commonly between 10 to 12 years of age.

Causes and Risk Factors

Sever’s disease results from repetitive stress to the growing heel bone, often due to activities like running and jumping. Key risk factors include:

  • High activity levels
  • Running on hard surfaces
  • Rapid growth phases
  • Inappropriate or worn-out footwear
  • Lower leg muscle weakness
  • Obesity
  • Poor biomechanics

Sever’s Symptoms

Parents may notice their child:

  • Limping or walking awkwardly
  • Experiencing pain when rising onto tiptoes
  • Complaining of heel pain, which could affect one or both heels

Diagnosis and Biomechanical Considerations

A physiotherapist can diagnose Sever’s disease through history and clinical tests, such as the “squeeze test”. Factors contributing to the condition include:

  • Limited ankle dorsiflexion
  • Abnormal hindfoot motion (overpronation or supination)
  • Tight calf muscles
  • Excessive weight-bearing activities

Duration and Long-term Effects

  • Duration: Typically, two weeks to a few months, varying with activity levels and growth rates.
  • Long-term Effects: If poorly managed, it can lead to permanent bone deformity at the heel, shoe-fitting difficulties, foot arch problems, and tight calf muscles.

Managing Sports Participation

Participation in sports depends on the severity of pain. Physiotherapists often recommend reducing or modifying activities to facilitate faster recovery.

Sever's disease
Sever’S Disease

Comprehensive Treatment Approach

Phase 1: Early Injury Protection

  • Rest, ice, and protect the heel
  • Use of pain relief methods like paracetamol (consult a doctor)
  • Shock-absorbing heel cups or soft orthotics

Phase 2: Regaining Range of Motion

  • Addressing stiff joints in the foot and ankle

Phase 3: Restoring Foot Arch Muscle Control

Phase 4: Leg Muscle Control

  • Enhancing overall leg muscle function

Phase 5: Correcting Foot Biomechanics

Phase 6: Enhancing Running and Landing Techniques

  • Technique correction to prevent recurrence

Phase 7: Footwear Analysis

  • Choosing appropriate footwear to reduce injury risk

Orthotics and Heel Cups

  • Used for temporary or long-term biomechanical correction
  • Helpful during the acute phase to alleviate symptoms
  • Read more: Heel Cups

Preventive Measures

  • Ensuring good joint and muscle flexibility
  • Monitoring and adjusting weight-bearing activities
  • Addressing foot arch issues

Listening to Your Child

  • Take heel pain in children aged 8 to 12 seriously
  • Seek professional advice for accurate diagnosis and management


Sever’s disease, while temporary, requires careful management to prevent long-term complications. Early intervention, guided by a physiotherapist, can ensure a swift and effective recovery. Stay vigilant to your child’s symptoms and consult a healthcare professional for tailored advice and treatment.

Seek Professional Advice

For specific concerns or symptoms, it’s crucial to consult a physiotherapist. They can provide individualised care and guide you through the recovery process. Remember, the information provided here is general and should not replace professional advice.

Common Heel Pain Causes

What's Causing Your Heel Pain?

This article digs into various heel pain and injury conditions that often trouble individuals. From the well-known discomfort of plantar fasciitis to the presence of heel spurs, we'll navigate through prevalent issues that impact our mobility.

Alongside discussions about frequently asked questions and recommended products, our exploration extends to traumatic ankle ligament injuries, tendon problems, foot injuries, bone fractures, degenerative conditions, biomechanical issues, nerve-related sources, muscle injuries, and systemic conditions. This comprehensive guide aims to provide clarity and understanding for those dealing with ankle and foot discomfort.

heel pain
Heel Pain

Heel Pain

FAQs & Products

Traumatic Ankle Ligament Injuries

Tendon Injuries

Foot Injuries

Bone Injuries

Degenerative Conditions

Soft Tissue Inflammation

Biomechanical Conditions

Nerve-Related Sources

Muscle Injuries

Systemic Conditions

General Information

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