Sever’s Disease

Sever’s disease, also known as calcaneal apophysitis, is the most common cause of heel pain in children. It typically affects physically active children and adolescents who participate in regular sports. A hallmark symptom is heel pain without any history of trauma.

What is Sever’s Disease?

Sever’s disease is a condition in children where pain occurs at the growth plate of the heel bone (calcaneus).

Children and adolescents have growth plates—areas of developing cartilage near the ends of long bones—that allow the bones to lengthen. As growth completes, these plates eventually close and turn into solid bone. Until then, the growth plates are vulnerable to repetitive stress, especially in active children.

In Sever’s disease, the heel’s growth plate becomes painful due to irritation. This is the same area where the Achilles tendon—the strongest tendon in the body—attaches. Repetitive running or jumping activities place tension on the Achilles tendon, which can irritate the cartilage at the heel growth plate and cause pain. A similar condition that affects the knee is called Osgood-Schlatter disease.

Who Is at Risk for Sever’s Disease?

Sever’s disease is commonly seen in growing children who are involved in sports that require frequent running and jumping. It often occurs during periods of rapid growth.

Most commonly affected individuals:

• Children between the ages of 8 and 15

• Youth athletes and physically active children

What Are the Symptoms of Sever’s Disease?

The most common symptom is pain at the back of the heel, especially after physical activity. The pain is localized to the area of the growth plate. It may worsen after sports and can sometimes be accompanied by warmth, redness, or swelling in the heel.

If the pain is located more on the outer side of the heel, especially in athletes, it may be due to a different condition involving the calcaneocuboid joint. In that case, we recommend reading our article on Cuboid Syndrome.

These are considered serious symptoms of Sever’s Disease, and early diagnosis and treatment are crucial. Don’t hesitate to reach out to us through our contact channels.

How Is Sever’s Disease Diagnosed?

Diagnosis is based on a detailed physical examination and medical history. In some cases, X-rays may be needed to rule out other causes of heel pain that affect the same region.

How Does Sever’s Disease Resolve?

Sever’s disease is a self-limiting condition that typically improves with appropriate treatment. Conservative (non-surgical) approaches are usually sufficient. The primary goals are to reduce pain and inflammation.

Treatment often includes:

• Rest and Activity Modification

• Ice Application

• Stretching and Strengthening Exercises for Sever’s Disease

• Use of Orthotics or Heel Cushions

How Is Sever’s Disease Treated?

The primary goal in the treatment of Sever’s disease is to control pain while allowing the child to continue normal physical activities. Once the child’s growth plates close at the end of puberty, the heel pain caused by Sever’s disease typically resolves on its own.

Rest and Activity Modification:The child should temporarily avoid high-impact sports and activities that trigger pain. This rest period may last around 2 months. However, in most cases, it is safe to allow sports participation as tolerated since Sever’s disease does not cause permanent damage.

Ice Therapy:Cold packs can be applied to the painful area at the back of the heel. An ice gel pack or a bag of ice wrapped in a thin cloth should be placed on the heel for 15–20 minutes. This can be repeated every hour, 3–4 times a day, to help reduce inflammation and relieve pain.

Stretching Exercises:Stretching the calf muscles is one of the most effective treatments for Sever’s disease. These exercises may initially cause a temporary increase in pain, which is normal. When done regularly, the calf muscles lengthen, which helps reduce the stress on the heel's growth plate.

Use of Orthotics:A heel lift (about 1 cm) placed inside the shoe can help alleviate pain by reducing strain on the heel. In some cases, we recommend the use of child-specific heel cups to provide additional cushioning and support.

What Happens If Sever’s Disease Is Not Treated?

If left untreated, Sever’s disease may result in persistent heel pain. This can interfere with daily activities and sports participation, ultimately reducing the child’s quality of life. Over time, chronic pain and alterations in gait (walking pattern) may develop, leading to additional biomechanical problems.

Recovery Time for Sever’s Disease

Recovery duration varies depending on the child’s activity level and adherence to treatment. Most children show significant improvement within a few weeks when proper treatment and lifestyle modifications are implemented.

Typical Recovery Timeline:

• Weeks 1–3: Noticeable reduction in pain

• Weeks 3–6: Gradual return to sports and physical activity

• After 6 weeks: Full recovery and return to previous activity level

Conclusion

Sever’s disease is a common cause of heel pain in growing children, particularly in young athletes. It is characterized by pain at the growth plate of the heel bone due to repetitive stress and physical activity.

Diagnosis is made through clinical evaluation and, when necessary, X-rays. Treatment is conservative and includes rest, ice application, stretching exercises, and sometimes orthotics.

If not treated properly, it may negatively affect the child’s daily life and sports performance. However, with appropriate care, most children recover quickly and return to their usual activities pain-free.

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