Heel pain is a common issue in growing, active children, and one of the most common causes of heel pain is a condition called Sever’s disease. Despite the name, it isn’t an illness or infection. Instead, it’s an inflammation of the growth plate at the back of the heel, most often seen during rapid growth phases. Because the growth plate is softer than mature bone, it is more vulnerable to overuse, traction, and pressure during sporting activities.
If your child has been complaining of heel pain after running and jumping, this guide explains the causes, signs and symptoms, diagnosis, and management options.
What Is Sever’s Disease and Why Does Heel Pain Occur?
Sever’s disease, also known as calcaneal apophysitis, is a common cause of heel pain in children between the ages of 8 and 12. It is slightly more common in boys than girls and usually affects children aged 8 – 12 years who are physically active. The condition develops when the growth plate in the heel becomes irritated during a growth spurt.
During this stage, muscles and tendons may tighten faster than the bones lengthen. The Achilles tendon, a large tendon connecting the back of the leg to the heel bone, can place extra stress on the heel and especially the growth plate at the back of the heel bone. This results in pain and inflammation, which may flare during running and jumping activities.
Sever’s disease is a common cause of heel issues in children and adolescents who play sports that involve a lot of running or changes in direction. It is also known as calcaneal apophysitis because the disease may affect part of the growth area where the Achilles tendon attaches. This inflammation of the growth plate can also appear in less active children who wear flat shoes or footwear with studs.
Although painful, the condition is temporary and resolves once the growth plate finishes developing.
Signs and Symptoms of Sever’s Disease
Understanding the signs and symptoms can help parents know when it’s time to seek advice from a health professional. Symptoms of Sever’s disease include:
- Heel pain that worsens during physical activity
- Pain when squeezing the sides of the heel or the back of the heel
- Mild pain and swelling
- Stiffness after rest
- Limping, walking on toes, or avoiding pressure on the heel
- Pain may be present in one or both heels
Heel pain in children is often most noticeable after sport or heavy activity and improves with rest. Symptoms may come and go, particularly during periods of rapid growth.
Causes of Heel Pain in Growing Children
There are several causes of heel pain in children, but Sever’s disease is one of the most common. Other common causes of heel discomfort may include poor footwear, biomechanical issues such as flat feet, impact from hard surfaces, or conditions like arthritis, though arthritis is far less common in children.
In Sever’s disease, the primary causes of heel discomfort include:
- Tight calf muscles or calf muscle tension
- A rapid growth spurt
- Increased pressure on the heel during sports
- High-impact or repetitive loading
- Tight muscles and tendons pulling on the heel bone
- Running and jumping sports
- The plate in the heel becomes irritated due to traction forces
Sports that involve sprinting, jumping, or sudden stops can aggravate the growth plate of the calcaneus, especially in children who play sports such as football, tennis, basketball, netball, and athletics.
How Do Health Professionals Diagnose Sever’s Disease?
A podiatrist or physiotherapist may diagnose Sever’s disease through a physical examination. They will discuss your child’s symptoms, running and jumping activities, recent changes in sporting activities, and whether the pain worsens with activity and improves with rest.
To diagnose Sever’s disease, a health professional may:
- Apply pressure to the heel
- Check for tenderness at the back of the heel
- Assess calf flexibility
- Observe your child walking or running
An x-ray is not usually required but may be used to rule out other causes such as fractures. A local doctor or physiotherapist might refer your child to a podiatrist if symptoms persist or interfere with daily life.
At Frenchs Forest Foot Care, we regularly assess children and adolescents with calcaneal apophysitis through our Children’s Podiatry service.
Management and Treatment: Helping Reduce Pain and Maintain Activity
Managing Sever’s disease focuses on reducing pain and maintaining physical activity in children and adolescents. Treatment depends on the severity of the pain and how much it affects walking or sport.
1. Activity Modification
The first step in managing Sever’s disease is reducing activities that cause discomfort. Low-impact options such as swimming or cycling allow children to stay active without aggravating symptoms.
2. Ice and Anti-Inflammatory Support
Ice can help reduce pain and swelling after sport. Pain relief medication such as ibuprofen may also help when used as directed.
3. Heel Support and Footwear
Supportive footwear and cushioned heel inserts can help reduce pressure on the growth plate. Avoiding the use of shoes with studs can also reduce irritation.
4. Stretching and Physiotherapy
A podiatrist or physiotherapist may recommend gentle stretching for the calves and Achilles tendon. This can improve flexibility and reduce traction forces on the heel bone.
5. Podiatry and Biomechanical Assessment
If symptoms may relate to foot posture or gait, a podiatrist can assess for contributing factors and recommend interventions such as heel lifts, footwear changes, or an exercise program. You can learn more about our biomechanical approach in our Biomechanical & Gait Assessments.
6. Temporary Immobilisation
In more severe cases, a child with Sever’s disease may need a walking boot or short-term support to allow the growth plate to settle.
These interventions in reducing pain are effective, and treatment includes a combination of rest, stretching, heel support, and footwear changes. Treatment described in clinical guidelines highlights that reducing pain and maintaining physical activity is key for recovery.
Recovery and Long-Term Outlook
Sever’s disease causes heel pain but is temporary. Most children recover within weeks to months, although symptoms may return if sporting loads increase too quickly. Once the heel bone stops growing, the condition does not return.
Children who play sports and adolescents with calcaneal apophysitis can return to normal activities once pain settles. Ongoing stretching and supportive shoes can help prevent flare-ups.
When to Seek Help
If your child is experiencing heel pain that interferes with daily life or sport, professional guidance can help. A podiatrist can support diagnosis and treatment while ensuring your child remains active and comfortable.
Visit our Contact page to book an appointment with Frenchs Forest Foot Care, or explore our services for General Foot & Nail Care or Injury & Pain Management.