Sever’s Disease: A Common Cause of Heel Pain in Active Children

Reviewed by the Physiotherapy Team at Waterloo Sports Medicine Centre 

Is your child complaining of heel pain after running or playing sports? They may have Sever’s disease, one of the most common causes of heel pain in growing children and adolescents. 

Despite its name, Sever’s disease is not actually a disease. It is a temporary overuse injury that affects the growth plate in the heel and typically resolves once a child finishes growing. With the right treatment, most children are able to return safely to their favorite activities. 

What Is Sever’s Disease? 

Sever’s disease, also known as calcaneal apophysitis, is an overuse injury that occurs when the growth plate (apophysis) at the back of the heel becomes irritated. It develops because the heel bone often grows faster than the surrounding muscles and tendons during growth spurts. Repeated pulling of the Achilles tendon on the growth plate can lead to pain and inflammation.

Sever’s disease most commonly affects children between 8 and 14 years of age, particularly those who participate in running and jumping sports. 

What Causes Sever’s Disease? 

Sever’s disease is caused by repetitive stress on the heel during periods of rapid growth. 

Common contributing factors include: 

• Growth spurts 

• Running and jumping sports 

• Repetitive training or overuse 

• Tight calf muscles or Achilles tendon 

• Sudden increases in sports participation 

• Poorly fitting or worn-out footwear 

• Flat feet or high arches in some children

  
  

Sports commonly associated with Sever’s disease include: 

• Soccer 

• Basketball 

• Volleyball 

• Gymnastics 

• Track and field 

• Hockey 

  
  

Common Symptoms 

Children with Sever’s disease may experience: 

• Pain at the back or bottom of the heel 

• Pain that worsens during or after sports 

• Tenderness when squeezing the sides of the heel 

• Limping after activity 

• Stiffness when first getting out of bed or after resting 

• Pain that improves with rest but returns with activity 

Symptoms often affect one heel but can occur in both. 

How Is Sever’s Disease Diagnosed? 

A physiotherapist or healthcare provider can often diagnose Sever’s disease based on your child's symptoms, medical history, and a physical examination. 

Imaging, such as X-rays, is usually not required, but may be recommended to rule out other causes of heel pain if symptoms are unusual or severe.

How Can Physiotherapy Help? 

Physiotherapy can help reduce pain, improve flexibility, and safely return your child to sports while minimizing the risk of recurrence. 

Treatment may include: 

Activity Modification 

Reducing or temporarily modifying activities that increase heel pain while keeping your child as active as possible. 

Stretching Exercises 

Tight calf muscles can increase stress on the heel. Stretching the calf muscles and Achilles tendon may help reduce tension on the growth plate. 

Strengthening Exercises 

Exercises to improve strength in the calf, foot, ankle, and hip muscles can improve lower limb mechanics and reduce stress on the heel. 

Manual Therapy 

Hands-on techniques may help improve ankle mobility and reduce muscle tightness. 

Footwear and Orthotic Advice 

Supportive footwear, heel cups, or custom foot orthotics may be recommended for some children to reduce stress on the heel during sports. At the Waterloo Sports Medicine Centre, we offer custom orthotics services by a certified pedorthist.   

When Should You See a Physiotherapist? 

Consider booking an assessment if your child has: 

• Heel pain that lasts more than a few days 

• Pain that limits sports or recreational activities 

• Limping during or after activity 

• Recurring heel pain during growth spurts 

• Symptoms that are not improving with rest 

Early assessment can help identify the cause of heel pain and prevent symptoms from worsening. 

Is your child experiencing heel pain after sports? The physiotherapists at Waterloo Sports Medicine Centre can assess the cause of your child's symptoms and develop a personalized treatment plan to help them return safely to the activities they enjoy.