Understanding Sever's Disease in Growing Children
Understanding Sever’s Disease: A Common Cause of Heel Pain in Growing Children
Heel pain in children can be a confusing and sometimes alarming experience for parents and young athletes. One of the most frequent culprits is Sever’s disease, also known as calcaneal apophysitis. While the name may sound daunting, this condition is not actually a “disease” in the traditional sense, but rather a growth-related overuse injury.
What is Sever’s Disease?
Sever’s disease primarily affects children between the ages of 8 and 14, especially those in the middle of a growth spurt. During this rapid period of development, bones often grow faster than the muscles, tendons, and ligaments that support them. This mismatch creates increased tension and pulling on the growth plate (apophysis) at the back of the heel bone (calcaneus).
The result? Pain, inflammation, and tenderness in the heel, usually felt at the point where the Achilles tendon attaches to the calcaneus. Children often describe it as a dull ache or sharp discomfort, especially during or after sports.
Common Signs and Symptoms
Sever’s disease typically presents with:
Heel pain at the back or underside of the calcaneus, often on both sides.
Pain during physical activity, especially running, jumping, or sports that involve sudden stops and starts.
Tenderness when the heel is squeezed from both sides.
Stiffness in the morning or after periods of rest.
Limping or altered gait, as kids may try to avoid putting pressure on the affected heel.
Unlike other causes of heel pain, Sever’s disease does not usually involve swelling, redness, or bruising.
Risk Factors
Several factors can increase the likelihood of developing Sever’s disease:
Sports during growth spurts – Activities like soccer, basketball, gymnastics, and running place repetitive stress on the heel’s growth plate.
Restrictive or unsupportive footwear – Shoes that are too tight or lack proper heel support amplify strain on the calcaneus.
Rapid growth – Growth spurts often outpace the flexibility of tendons and muscles, leaving the heel vulnerable.
Biomechanical issues – Flat feet, high arches, or abnormal gait mechanics may contribute.
Lack of screening in sports physicals – Without attention to growth stages, kids may be pushed into high training loads at vulnerable times.
Diagnosis
Accurate diagnosis is essential to ensure proper treatment and avoid unnecessary worry. A skilled clinician will rely primarily on a thorough history and physical examination rather than imaging. Key diagnostic clues include age, recent growth spurts, sports participation, and the characteristic tenderness on heel squeeze.
X-rays are not typically required unless another condition is suspected.
Treatment Options
The good news: Sever’s disease is self-limiting, meaning it resolves once the growth plate closes and the bone matures. However, treatment is crucial for reducing pain, maintaining activity, and preventing compensatory movement issues.
Common strategies include:
1. Rest and Activity Modification
Limiting high-impact activities gives the heel a chance to recover. Complete rest is not always necessary—children can often switch to lower-impact activities like swimming or cycling.
2. Immobilization
In severe cases, a walking boot or heel cup may be used temporarily to offload stress.
3. Isometric Exercises
Gentle calf and foot strengthening exercises help improve tendon tolerance without overloading the heel.
4. Motor Control Training
Re-educating movement patterns—especially in running and jumping—helps reduce stress on the heel and prevents future recurrence.
5. Dry Needling and Manual Therapy
In some cases, clinicians may use dry needling, massage, or other manual techniques to reduce muscle tension and improve function.
6. Supportive Footwear
Shoes with adequate cushioning and heel support, or the use of orthotic inserts, can reduce strain.
The Individualized Approach
As with most musculoskeletal conditions, treatment must be tailored to the individual child. The severity of symptoms, sport demands, and underlying biomechanics all play a role in determining the best approach. For young athletes especially, balancing rest with safe return-to-play strategies ensures they stay active without long-term complications.
Key Takeaway
Sever’s disease may sound intimidating, but with the right approach, it is a manageable and temporary condition. Parents, coaches, and clinicians should be aware of the warning signs and take proactive steps to address pain early. With proper rest, supportive care, and gradual return to activity, most children make a full recovery and continue to thrive in their chosen sports.
