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Sever’s disease, also known as calcaneal apophysitis, is a common cause of heel pain in growing children and adolescents. It occurs when the growth plate at the back of the heel becomes inflamed due to repetitive stress and tension. This condition is most often seen in physically active children between the ages of 8 and 14, particularly those involved in sports that require running and jumping. Despite its name, Sever’s disease is not an actual disease but rather a temporary growth-related condition.

Signs & Symptoms

Children with Sever’s disease typically experience:

  • Pain and tenderness at the back or bottom of the heel, particularly during or after physical activity
  • Swelling or redness around the heel
  • Stiffness in the heel, especially in the morning
  • Pain that worsens with running, jumping, or standing for long periods
  • A limp or walking on tiptoes to avoid putting pressure on the heel
  • Pain when squeezing the sides of the heel

Symptoms usually affect both heels, although one side may be worse than the other. The pain generally improves with rest and worsens with activity.

Causes and Contributing Factors

Sever’s disease occurs due to stress and irritation of the growth plate in the heel. The growth plate is an area of developing bone where new bone tissue is formed. During growth spurts, this area is more vulnerable to injury.

Factors that contribute to Sever’s disease include:

  • Growth spurts – Rapid bone growth can cause muscles and tendons to become tight, increasing tension on the heel.
  • Repetitive stress – Running, jumping, and high-impact activities put strain on the growth plate.
  • Tight calf muscles and Achilles tendon – This can pull on the heel bone and aggravate the growth plate.
  • Flat feet or high arches – Abnormal foot mechanics can alter weight distribution, increasing stress on the heel.
  • Inappropriate footwear – Worn-out or unsupportive shoes can fail to absorb shock and protect the heel.
  • Excess weight – Carrying extra body weight increases the load on the heels, worsening symptoms.

Prognosis

Sever’s disease is a self-limiting condition, meaning it resolves on its own once the growth plate fully develops and hardens, usually by the mid-teens. Symptoms typically last a few months but can persist intermittently for up to two years, depending on activity levels and management strategies. With proper treatment, most children can continue participating in sports with minimal discomfort.

Treatment

The primary goals of treatment are to reduce pain, manage inflammation, and modify activities to prevent worsening symptoms. Physiotherapy plays a key role in recovery.

Activity Modification

  • Limiting high-impact activities (e.g., running, jumping) during painful episodes
  • Encouraging low-impact activities such as swimming or cycling
  • Avoiding walking barefoot on hard surfaces

Footwear and Orthotics

  • Wearing well-cushioned, supportive shoes with shock-absorbing soles
  • Using heel pads or orthotics to reduce pressure on the growth plate

Physiotherapy and Rehabilitation

A physiotherapist can provide:

  • Stretching exercises – Gentle stretching of the calf muscles and Achilles tendon to reduce tension on the heel
  • Strengthening exercises – Strengthening the foot and lower leg muscles to improve stability and support
  • Manual therapy – Soft tissue massage and joint mobilisation techniques to relieve tightness and discomfort
  • Biomechanical assessment – Identifying and addressing issues such as flat feet or altered walking patterns that may contribute to pain
  • Taping or bracing – Techniques to support the heel and reduce strain during activities

Pain Management

  • Applying ice packs to the heel for 10–15 minutes after activity to reduce inflammation
  • Using non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, if needed for pain relief (only under medical advice)

Return to Sport

Once pain subsides, children can gradually return to full activity. Our physiotherapists can help provide eduction and guide them through a graded return-to-sport program, ensuring proper warm-up, stretching, and strengthening to prevent recurrence.