Conditions
Sever's Disease
Reviewed by Anureet Selach, Podiatrist · Australian Podiatry Association · Registered with AHPRA
Last updated
A child aged eight to fifteen, limping after sport, complaining of heel pain, sometimes walking on their toes to avoid putting the heel down. It’s worse during or after activity and better with rest.
That’s calcaneal apophysitis, better known as Sever’s disease, and it’s the most common cause of heel pain in active children.
What’s happening
There’s a growth plate at the back of the heel bone. During a growth spurt the bone lengthens faster than the calf muscles and Achilles tendon can adapt, so the tendon pulls harder on a growth plate that hasn’t fused yet. Repeated impact on top of that irritates it.
The name sounds alarming and shouldn’t. It causes no lasting damage and it resolves once the growth plate closes, typically around fourteen or fifteen.
What brings it on
Repetitive impact is the trigger — running, jumping, sport on hard surfaces — and these raise the risk:
- Tight calf muscles
- Limited ankle flexibility
- Flat feet or high arches
- Toe-walking
- A jump in training load or intensity
- Time barefoot on hard floors
- Unsupportive footwear, including school shoes
It can affect one heel or both, and it flares with activity.
What treatment involves
Your podiatrist will assess the foot, the ankle range of motion, the calf, and how your child is walking and running, then work through:
- Load management. Reducing the amount and the intensity of impact for a period, rather than stopping sport altogether.
- Calf stretching and strengthening. This is the part that addresses the cause, and it continues after the pain has gone.
- Footwear. A supportive shoe with a small heel raise reduces the pull on the growth plate. School shoes are frequently the problem.
- Heel raises or cushioning to offload the area while it settles.
- Orthotics where foot mechanics are contributing.
- Activity advice, including reducing time barefoot on hard surfaces.
Left unmanaged it can drag on for months, and a child who stops enjoying sport because of it is the real cost. It responds well to being taken seriously early.
Frequently asked questions
Is it actually a disease?
No, and the name is unhelpful. Calcaneal apophysitis is irritation of the growth plate in the heel bone during a period of rapid growth. It's self-limiting — it resolves once the growth plate fuses — and it causes no long-term damage.
Does my child have to stop sport?
Usually not. Complete rest settles it and it returns as soon as they go back, because nothing changed. Reducing load — fewer sessions, softer surfaces, less jumping for a period — works better and keeps them involved.
How long does it last?
Flares typically settle over weeks with the right management, but it can recur through a growth spurt until the growth plate closes, usually around 14 or 15. That's why it's managed rather than cured, and why the calf stretching continues after the pain goes.
Why both heels?
Because it's driven by growth, and both heels are growing. Bilateral presentation is common and doesn't mean it's worse.
Do we need an X-ray?
Not usually. It's diagnosed from the history and examination. Imaging is used where the presentation is unusual, where there's a history of significant injury, or where something else needs excluding.
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