Sever's disease (heel pain)
Sever's disease is one of the most common causes of heel pain in physically active children and adolescents. It is caused by irritation of the calcaneal apophysis, a growth area of the heel bone where the Achilles tendon attaches. It is especially common during periods of rapid growth. Treatment is usually non-surgical and allows a gradual return to sport once the pain has gone.
- Typical age
- Roughly between 8 and 14 years of age; earlier in girls than in boys
- Also known as
- Calcaneal apophysitis · Heel pain in children
What it is
Sever’s disease is a painful inflammation of the posterior apophysis of the calcaneus, the part of the heel bone where the Achilles tendon attaches. During childhood and adolescence, this area contains growth cartilage that has not yet fully turned into mature bone.
During growth spurts, the combination of the pull of the Achilles tendon and repeated impact from running, jumping or training can irritate this area. That is why the pain often appears in children who play sport regularly —football, basketball, athletics or gymnastics, for example—, especially when training becomes more intense or more frequent.
Sever’s disease is not usually caused by a significant injury and does not mean the bone is broken. It is a problem related to growth and to the mechanical load on the heel. It can affect one foot or both, and the pain may come back over a season if the child returns to intense activity before being ready.
Once the calcaneus matures and the growth cartilage closes, the problem usually goes away for good.
Signs parents may notice
The most common symptoms are:
- Pain at the back or underside of the heel, especially when running and jumping.
- Limping after training or at the end of a sports activity.
- Pain that gets worse with exercise and better with rest.
- Tenderness when gently squeezing the sides of the back of the heel.
- Needing to train less intensely or stop the sport because of pain.
- Walking on tiptoe to avoid putting weight directly on the heel.
- Discomfort in one or both feet, not necessarily after a knock.
In some children the pain at first appears only during sport. If the irritation increases, it may also appear when walking or after long periods of activity.
When to see a specialist
It is advisable to see a specialist if heel pain persists, limits sport or keeps coming back.
Ask for an assessment when:
- The pain forces the child to stop training or makes them limp.
- The discomfort does not improve after temporarily reducing activity.
- The pain also appears at rest or at night.
- There is marked swelling, redness or local warmth.
- The pain is very severe, starts suddenly after an injury, or the child cannot put weight on the foot.
- It comes with fever or general malaise.
When is it urgent?
Being unable to put weight on the foot, fever together with localised pain, or severe and worsening pain require urgent medical assessment to rule out other causes.
How it is diagnosed
Sever’s disease is diagnosed mainly through clinical examination. The specialist asks when the pain appears, which sports the child plays, how it has evolved and whether there have been recent changes in training load.
The examination locates the painful spot, checks tenderness over the calcaneal apophysis and assesses ankle mobility, Achilles tendon tightness and foot mechanics.
X-rays are not needed in every case. They may be requested when the picture is atypical, there has been an injury, the pain persists or other causes need to be ruled out. Images may show changes in the apophysis, but these are also seen in children without symptoms and do not confirm the condition on their own.
If there are warning signs or the course is not as expected, the specialist may order other tests to rule out bone injuries, tendon problems or other conditions.
Treatment
Treatment is non-surgical: reducing painful activities and adapting training, with a gradual return to sport (see Outlook and recovery).
It consists of applying ice to the heel 3–4 times a day, doing gentle stretches of the calf muscles and the Achilles tendon, and using a silicone heel cup to cushion impact and reduce tension on the heel.
In more chronic cases, especially when there is an associated Achilles tendinopathy, complementary treatments such as shockwave therapy or INDIBA therapy may be considered, depending on how things progress.
Surgical treatment
Sever’s disease does not require surgery. It is a self-limiting condition related to growth, and surgery is not indicated for ordinary calcaneal apophysitis.
If the pain persists for a long time, it is important to review the diagnosis and rule out other causes of heel pain before considering additional treatments.
Outlook and recovery
The outlook is usually good, and the pain goes away as the load on the heel is controlled and the growth cartilage matures. However, discomfort can return over several months, especially if the child is still growing and keeps up intense sport.
As a general guide:
- First 1–2 weeks: reduce painful activities, adapt training and use heel cups if recommended.
- Over the following weeks: gradually regain mobility and tolerance to load, guided by symptoms.
- Back to school: there is usually no need to miss school, unless walking is very painful and activity has to be adapted for a while.
- Back to sport: when the child walks without pain, has no significant discomfort when the heel is pressed, and can run, jump and perform sport-specific movements without pain during or after activity.
Recovery may take a few weeks, although some cases last several months and may come and go until the calcaneus has finished maturing. There is no single timeframe that applies to every child.
The return to sport should be gradual, increasing duration first and then intensity. If the pain comes back, reduce the load and reassess the progression.
This page is for general information and does not replace an assessment by a specialist. If you are worried about your child's foot, talk to their paediatrician or book an appointment.