Sever’s disease, also known as calcaneal apophysitis, is a common cause of heel pain in growing children, particularly those who are physically active and busy with sports. While the name might sound daunting, it is a manageable condition with the right care and treatment protocol. In this blog, we’ll explore what Sever’s disease is, its symptoms, causes, and effective treatment strategies to help your child get back to their favorite activities pain-free!

What is Sever’s Disease?

Sever’s disease is an inflammation of the growth plate of the heel, also call the calcaneus. A growth plate is a soft area of cartilage where bone growth occurs. In children and adolescents, growth plates are more prone to injury than the surrounding bone, making them susceptible to conditions like Sever’s disease during growth spurts.

Symptoms of Sever’s Disease

The hallmark symptom of Sever’s disease is heel pain, which can range from mild to severe. Here are the key signs to watch for:

  • Heel Pain & Tenderness: Usually located at the back of the heel, where the Achilles tendon meets the heel bone. Pain may be felt on one or both sides. In severe cases, pain may radiate to the bottom of the heel.
  • Swelling and Redness: The heel may appear swollen and red, especially immediately after activity. This often improves with rest.
  • Limping or Toe-Walking: The heel is often so tender that children may not allow their parents to touch the site. Tenderness can lead the child to walk on their tiptoes to avoid putting pressure on the heel. The child may also be seen walking with a limp, especially after completing a sporting activity.
  • Pain with Activity: The pain typically worsens with physical activities such as running, jumping, and playing sports, and improves with rest. Sports that require the use of narrow shoes and cleats can exacerbate the symptoms.

Causes of Sever’s Disease

Several factors can contribute to the development of Sever’s disease:

  • Growth Spurts: Rapid bone growth during puberty, typically around ages 8-14, can cause the muscles and tendons to become tight. Tightness in the posterior chain and calf muscle places significant strain at the site of the calcaneal growth plate and increases the risk of Sever’s disease.
  • Physical Activity: High-impact sports like soccer, basketball, and gymnastics put extra stress on the heel. When children are enrolled in sports year-round, they are not provided with a period of time to allow their bodies to rest and heal. Kids that are overly fatigued because of a lack of rest will be at a greater risk of developing Sever’s disease.
  • Improper Footwear: Wearing shoes without adequate support can exacerbate heel pain. Wearing cleats can be especially challenging in the setting of Sever’s disease. Cleats are made with a narrow last that places significant pressure on the heel.
  • Biomechanical Issues: Flat feet, high arches, or other foot deformities can increase the risk. Over-the-counter arch support, such as the Little Steps we carry in our office, can improve biomechanical abnormalities in the foot and decrease the strain placed on the growth plate.

Diagnosing Sever’s Disease

At Bayshore Podiatry, a Sever’s disease diagnosis is based on a physical examination, the patient’s medical history, and an x-ray of the affected foot. The doctor may ask about recent growth spurts, activity levels, and specific symptoms. We encourage parents to bring shoes to the appointment that the child is wearing when they play their sport, as well as what they wear to school.

Treatment and Management

While Sever’s disease can be painful, it is temporary and usually resolves with appropriate care. Here are some effective treatment strategies:

  • Rest: Limiting activities that cause heel pain is crucial. Encourage your child to rest and avoid high-impact sports until the pain subsides.
  • Ice Therapy: Applying ice to the affected heel for 15-20 minutes several times a day can help reduce inflammation and pain.
  • Stretching Exercises: Stretching the calf muscles and Achilles tendon can relieve tension and prevent further injury. You’ll be provided with specific stretches at your appointment in our office!
  • Supportive Footwear: Ensure your child wears shoes with good arch support and cushioned soles. Orthotic inserts may also be beneficial. In some cases, gel heel cups may be recommended.
  • Pain Relief: Over-the-counter pain medications like ibuprofen or acetaminophen can help manage pain and inflammation on an as-needed basis.
  • Physical Therapy: In some cases, a physical therapist can provide additional exercises and treatments to aid recovery.

Preventing Sever’s Disease

While it may not always be possible to prevent Sever’s disease, these steps can help reduce the risk:

  • Proper Footwear: Invest in good quality, supportive shoes for your child, especially for sports. Ensure cleats fit properly and are not too narrow. Invest in a set of Little Steps arch supports for your child to wear in their shoes.
  • Stretching: Encourage regular stretching of the calves and Achilles tendons, particularly before and after physical activities. Encourage your children to complete warm-ups and cool-downs as part of their practice.
  • Gradual Increase in Activity: Avoid sudden increases in physical activity levels. Gradually build up the intensity and duration of sports and exercises.
  • Rest Between Sports: Allow your child time to rest between seasons. Rest is vital to recovery and will ensure your child continues to grow optimally.

When to See a Podiatrist

If your child experiences persistent heel pain that interferes with daily activities or sports, it is important to consult a podiatrist. Early intervention can prevent the condition from worsening and speed up the recovery process. The sooner care is sought, the less time a child will spend away from their sport, which makes the whole family happy!


Sever’s disease, also known as calcaneal apophysitis, though uncomfortable, is a temporary condition that resolves with proper care and management. By understanding its causes, symptoms, and treatment options, parents can help their children navigate this common condition and get back to enjoying their favorite activities. If you have any concerns about your child’s heel pain, don’t hesitate to contact our office to schedule an appointment!

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