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Olympus Lifestyle Co

Condition

Sever's Disease

Heel pain in an active child or young teen, worse with running and jumping? Load management, heel raises and calf strengthening for Sever's disease, with reassurance for parents.

Sever’s disease is one of the most common causes of heel pain in active kids. It tends to show up in the sporty years from about 8 to 14, particularly in football, netball, basketball, athletics and gymnastics, and it often appears at the start of a season or after a growth spurt. It can be very sore, and it’s worrying for parents, but it’s harmless in the long term and responds well to sensible load management and strengthening.

Understanding Sever’s disease

In children, the heel bone has a growth area at the back, where the Achilles tendon and calf muscles attach. This area is softer than mature bone, and during growth spurts the bones can lengthen faster than the calf muscles, increasing the pull on the heel. Repetitive running and jumping then irritate the growth plate, particularly on hard surfaces or in poorly cushioned shoes.

It’s called calcaneal apophysitis in the medical literature, and it’s an overuse problem linked to load and growth, not to damage.

Symptoms we commonly see

  • Pain at the back or sides of the heel, often in both feet
  • Pain with running, jumping and sport, easing with rest
  • A limp or walking on tiptoes after activity
  • Pain on squeezing the sides of the heel
  • Heel pain first thing in the morning or after sitting, in some children
  • Tight calf muscles

Our evidence-based approach

Research on treatments for Sever’s disease is limited, but it suggests that several approaches help. Randomised trials have found that wait and see, heel raises and supervised exercise each led to clinically relevant improvements over about three months, and that heel raises offered a short-term advantage over other inserts. That supports a simple, load-based plan tailored to your child. Our approach includes:

  1. Assessment to confirm Sever’s disease and rule out stress fractures, tendon problems and other causes of heel pain
  2. Education for your child and parents, covering what’s happening, why it’s harmless in the long term and how to manage training
  3. Load management, adjusting the amount of running, jumping and hard-surface training so the heel can settle
  4. Heel raises or cushioning where they ease pain in the short term, and footwear advice
  5. Calf and foot strengthening, building the capacity of the muscles and tendon that load the heel
  6. Flexibility work where tight calves are contributing
  7. A graded return to full sport, with a plan for managing training load during growth spurts

See our plantar fasciitis and Achilles tendinopathy pages for other causes of heel pain in adults, and our Osgood-Schlatter page for the knee equivalent in growing teens.

What to expect: recovery timeline

  • First few weeks: pain often eases with reduced load and heel cushioning
  • Around three months: most children in the trials above had meaningfully improved
  • Until growth finishes: symptoms can flare with growth spurts or training peaks, but resolve as the growth plate matures

When to seek help urgently

Seek prompt assessment if your child has heel pain after a fall or injury, can’t put weight on the foot, has constant pain at rest or at night, or the heel is hot, red and swollen. Heel pain with fever or feeling unwell also needs prompt review.

References

How We Treat This

Sports PhysiotherapyPhysiotherapyStrength and Conditioning

Q & A

Questions about Sever's Disease

What is Sever's disease?

Sever's disease, or calcaneal apophysitis, is a common cause of heel pain in active children, typically between about 8 and 14. The Achilles tendon and calf muscles pull on the growth area at the back of the heel bone, and with lots of running and jumping during a growth spurt it becomes irritated and sore. It isn't a disease in the usual sense, and it settles as growth finishes.

Does my child have to stop playing sport?

Usually not completely. We adjust the amount of running, jumping and hard-surface training to a level the heel tolerates, and use short-term strategies like heel raises while it settles. A period of reduced load is often needed if pain is significant, but we aim to keep your child active and involved.

Do heel raises or orthotics help?

They can help comfort in the short term. In a 12-month trial, heel raises had a relative advantage over prefabricated orthoses at two months, but there were no differences between treatments at six and twelve months. Another randomised trial found that wait and see, a heel raise and supervised exercise each led to clinically relevant improvement over three months, so there's no single right answer and we tailor it to your child.

How do I tell Sever's disease from a stress fracture or Achilles problem?

Sever's disease typically causes pain at the back and sides of the heel that's worse with running and jumping, and squeezing the heel from both sides is usually sore. A stress fracture tends to cause constant, worsening pain, often at rest or at night. An examination sorts these out, and we refer for imaging if anything points to another cause.

How long will it last, and will it come back?

Most children improve over weeks to a few months once load is managed, but symptoms can return during further growth spurts or when training ramps up. Calf strength, sensible training loads and good footwear help reduce flare-ups, and it resolves once the heel growth plate matures.

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