Sever's Disease: Symptoms, Causes and Treatment for Heel Pain in Children
If your child complains of heel pain after football, running or other physical activities, they may have a condition called Sever's disease. It's one of the most common causes of heel pain in active, growing children. [1]
Sever's disease, also known as calcaneal apophysitis, occurs when the growth plate at the back of the heel becomes irritated. It commonly affects children between the ages of 8 and 14, particularly during periods of rapid growth.
Despite its name, Sever's disease isn't an infection or a disease in the traditional sense. It's a growth-related condition that usually improves with appropriate management and eventually resolves as the heel bone matures.
However, not every child with heel pain has Sever's disease. Persistent heel pain, difficulty walking or unusual symptoms should always be assessed to establish the correct diagnosis.
In this guide, we'll explain what causes Sever's disease, how to recognise the symptoms, which treatments can help and when your child can safely return to sport.
What Is Sever's Disease?
Sever's disease is a growth-related condition affecting the heel bone, known medically as the calcaneus.
At the back of the heel is an area of developing cartilage called the growth plate, or calcaneal apophysis. This area allows the heel bone to grow as a child develops.
During childhood, the growth plate is more vulnerable to irritation from repetitive physical activity.
The Achilles tendon attaches to the back of the heel bone. Running, jumping and other activities place repeated forces through this area.
During periods of rapid growth, these forces can contribute to irritation and pain around the developing growth plate.
This is known as calcaneal apophysitis, although it's more commonly called Sever's disease. [1, 2]
Unlike many adult causes of heel pain, Sever's disease is specifically associated with skeletal growth.
It isn't caused by an infection, and it doesn't mean your child's heel bone is permanently damaged.
What Causes Sever's Disease?
Sever's disease develops when repetitive loading irritates the growth plate at the back of the heel.
Several factors can contribute.
Rapid Growth
During a growth spurt, bones, muscles and tendons don't always adapt at exactly the same rate.
This can temporarily increase tension around the heel, particularly through the calf muscles and Achilles tendon.
As a result, activities that previously caused no problems may begin to produce heel pain.
Running and Jumping Sports
Sever's disease is particularly common in active children.
Activities involving repeated running, jumping and sudden changes of direction place additional stress around the heel.
Examples include:
Football
Rugby
Athletics
Basketball
Gymnastics
Dance
Tennis
However, children don't need to participate in competitive sport to develop the condition. [2]
Regular playground activities and recreational exercise can also contribute.
Increased Activity
A sudden increase in training or physical activity can trigger symptoms.
For example, heel pain may begin when a child returns to football after the summer holidays or starts attending additional training sessions.
Footwear
Footwear that provides insufficient cushioning or support may contribute to discomfort.
However, footwear alone doesn't cause Sever's disease, and buying expensive trainers isn't necessarily the solution.
Calf Muscle Tightness
Reduced flexibility around the calf muscles and Achilles tendon may contribute to increased loading around the heel.
This is one reason appropriate stretching and rehabilitation exercises are sometimes included in treatment.
Not every child with Sever's disease has tight calf muscles, so exercises should be recommended according to their individual assessment.
What Are the Symptoms of Sever's Disease?
The most common symptom is pain around the back or underside of the heel, particularly during or after physical activity.
Children may experience:
Pain at the back of the heel
Pain during running or jumping
Heel tenderness
Limping after exercise
Difficulty participating in sport
Pain affecting one or both heels
Discomfort when wearing certain shoes
Symptoms often develop gradually rather than following a specific injury.
Some children begin walking on their toes to avoid putting pressure on their painful heels.
Others may seem completely comfortable in the morning but experience increasing pain throughout a busy day.
Can Sever's Disease Affect Both Feet?
Yes. Sever's disease can affect one or both heels.
Some children initially experience symptoms in one foot before developing similar pain in the other.
However, pain affecting both heels doesn't automatically confirm the diagnosis.
A professional assessment is important, particularly if symptoms are severe or unusual.
How Is Sever's Disease Diagnosed?
Sever's disease is usually diagnosed through a clinical assessment rather than an X-ray. [3]
When assessing a child with heel pain, we'll consider their age, symptoms, activity levels and medical history.
A podiatrist or other appropriately qualified healthcare professional may examine:
The location of the pain
Tenderness around the heel
Walking and running patterns
Footwear
Ankle movement
Calf flexibility
The child's recent activity levels
Gentle compression around the sides of the heel may reproduce discomfort in some children.
However, no single clinical test confirms Sever's disease.
Does Sever's Disease Show Up on an X-ray?
An X-ray isn't usually necessary when the symptoms and examination findings are typical of Sever's disease.
The developing heel bone naturally changes appearance during childhood, and these changes can sometimes be mistaken for abnormalities.
Imaging may be considered if the diagnosis is uncertain or another condition needs to be excluded. For example, heel pain following a significant injury may require further investigation.
How Is Sever's Disease Treated?
Treatment focuses on reducing pain, managing the forces affecting the heel and helping your child remain appropriately active.
There isn't one treatment that works for every child.
The most suitable approach depends on symptom severity, activity levels and the findings of their assessment.
1. Modify Physical Activity
Activity modification is often one of the most important parts of treatment.
This doesn't necessarily mean stopping every activity or keeping your child completely inactive.
Instead, we recommend reducing or temporarily avoiding activities that significantly increase heel pain.
For example, a child may need to take a break from competitive football while continuing with comfortable everyday activities.
Lower-impact exercise, such as swimming or cycling, may be an option if it doesn't cause discomfort.
The aim is to maintain activity without repeatedly aggravating the heel.
2. Choose Supportive Footwear
Comfortable, supportive footwear can help reduce symptoms.
Look for shoes with:
Appropriate cushioning
A comfortable heel area
A secure fit
Sufficient room for the toes
A sole appropriate for the child's activities
Avoid footwear that places excessive pressure on the painful area.
Some children find walking barefoot on hard floors uncomfortable. Wearing supportive footwear indoors may help during symptomatic periods.
However, footwear recommendations should be individualised.
3. Consider Heel Cups or Heel Raises
Heel cups and heel raises may help some children with Sever's disease.
A cushioned heel cup can reduce discomfort during walking and physical activity.
A heel raise may temporarily reduce tension around the Achilles tendon and heel.
However, these products aren't suitable for every child, and they don't address every contributing factor.
We recommend seeking professional advice before purchasing expensive orthotics or making significant changes to footwear.
Exercises may form part of treatment, particularly when reduced ankle flexibility or muscle weakness contributes to symptoms.
A podiatrist or physiotherapist may recommend:
Gentle calf stretches
Appropriate ankle mobility exercises
Progressive calf strengthening
A gradual return to running and jumping
Exercises should be comfortable and appropriate for the child's symptoms.
Aggressive stretching, particularly when the heel is already painful, may aggravate the condition.
We don't recommend forcing a child to stretch through heel pain.
5. Cold Therapy
Applying a wrapped cold pack to the painful area after activity may provide temporary symptom relief.
Never apply ice directly to the skin.
Cold therapy can help manage discomfort, but it doesn't replace appropriate activity modification and rehabilitation.
6. Pain Relief
If necessary, a pharmacist or healthcare professional can advise on suitable age-appropriate pain relief.
Always follow the recommended dose and check that the medication is appropriate for your child.
Pain relief shouldn't be used simply to allow a child to continue playing sport despite significant heel pain. [4, 5]
Should Children Stop Playing Sport with Sever's Disease?
Not every child needs to stop participating in sport completely.
However, continuing to play through significant pain can prolong symptoms and make everyday activities uncomfortable.
We recommend adjusting activity according to symptoms rather than applying the same restrictions to every child.
A child with mild discomfort may tolerate modified training, while someone who is limping or experiencing substantial pain may need a temporary break.
A useful principle is that activity shouldn't cause significant pain, alter normal walking or leave symptoms noticeably worse afterwards or the following day.
If you're unsure how much activity is appropriate, ask your child's podiatrist or physiotherapist.
How Long Does Sever's Disease Last?
Sever's disease can last for several weeks or months, and symptoms may return during periods of rapid growth.
Recovery varies considerably.
Some children improve relatively quickly once aggravating activities are reduced and appropriate treatment begins.
Others experience recurring symptoms throughout their growing years. [1, 2]
The important distinction is that the condition is generally self-limiting. Once the heel growth plate matures and closes, Sever's disease resolves.
However, persistent or recurring pain shouldn't automatically be dismissed as growing pains.
If symptoms aren't improving, the diagnosis and treatment plan should be reviewed.
Can Sever's Disease Cause Permanent Damage?
Sever's disease isn't generally associated with permanent damage to the heel.
The condition usually resolves as the growth plate matures.
However, this doesn't mean symptoms should be ignored.
Persistent pain can interfere with sport, walking, school activities and a child's general wellbeing.
Appropriate management helps reduce discomfort and allows children to return to their usual activities safely.
Can Sever's Disease Come Back?
Yes. Symptoms can return, particularly during growth spurts or following an increase in physical activity.
For example, a child may improve after several weeks of reduced training but experience heel pain again when returning to frequent football sessions.
This doesn't necessarily mean the original treatment was unsuccessful.
It may indicate that the heel is being exposed to more activity than it can currently tolerate.
A gradual return to sport, appropriate footwear and an individualised exercise programme can help manage recurring symptoms.
Sever's Disease vs Plantar Fasciitis: What's the Difference?
Although both conditions can cause heel pain, they affect different structures.
Sever's disease involves irritation around the developing growth plate at the back of the heel. It occurs in growing children.
Plantar fasciitis affects the plantar fascia, a strong band of tissue running along the underside of the foot.
Plantar fasciitis commonly causes pain underneath the heel, particularly during the first steps after rest.
Sever's disease is more commonly associated with pain around the back of the heel during or after physical activity.
However, symptoms can overlap, and the location of pain alone isn't enough to establish a diagnosis.
Can Adults Get Sever's Disease?
No. Sever's disease specifically affects the developing growth plate in children and adolescents.
Once the growth plate has matured and closed, the condition can no longer develop.
Adults experiencing pain around the back of the heel may have another condition, such as Achilles tendinopathy, bursitis or a different cause of heel pain.
A proper assessment is important rather than assuming that heel pain has the same cause at every age.
How Can You Prevent Sever's Disease?
It's not always possible to prevent Sever's disease because growth and physical development are natural processes.
However, several measures may help reduce the risk of developing troublesome symptoms.
Increase Activity Gradually
Avoid sudden increases in training frequency or intensity.
This is particularly important when returning to sport after a holiday or period of reduced activity.
Choose Appropriate Footwear
Ensure your child's shoes fit properly and are suitable for their activities.
Remember that children's feet grow quickly, so check footwear regularly.
Encourage Recovery
Allow adequate recovery between demanding training sessions, particularly during growth spurts.
Children participating in several sports may be exposed to more cumulative activity than parents realise.
Respond to Early Symptoms
Don't encourage children to ignore persistent heel pain.
Early adjustments to activity may prevent mild discomfort from becoming more troublesome.
When Should You See a Podiatrist?
Arrange an assessment if your child:
Regularly complains of heel pain
Experiences pain during or after sport
Develops a limp
Avoids activities because of discomfort
Experiences recurring heel pain
Has symptoms that aren't improving
A podiatrist can assess the likely cause of the pain, examine your child's feet and footwear, and recommend an appropriate management plan.
Depending on the findings, they may also recommend physiotherapy or further medical assessment.
When Does Heel Pain Require Urgent Medical Attention?
Although Sever's disease is common, not every case of childhood heel pain is caused by growth-related irritation.
Seek prompt medical assessment if your child develops:
Severe pain following an injury
An inability to bear weight
Significant swelling
Fever or feeling generally unwell
A red, hot or unusually swollen heel
Persistent pain at rest or during the night
Unexplained or progressively worsening symptoms [3, 6]
These symptoms may indicate another condition that requires investigation.
We recommend avoiding self-diagnosis when a child has severe or unusual heel pain.
Final Thoughts
Sever's disease is one of the most common causes of heel pain in active, growing children. Although the name can sound concerning, it's generally a temporary condition associated with the developing heel bone.
The most important part of treatment is finding the right balance between activity and recovery.
Supportive footwear, appropriate activity modification and individualised rehabilitation can help manage symptoms while allowing children to remain as active as comfortably possible.
We recommend seeking professional advice if your child develops persistent heel pain, begins limping or struggles to participate in their usual activities.
With an accurate diagnosis and appropriate management, most children can return to the sports and activities they enjoy.
References
American Academy of Orthopaedic Surgeons (AAOS). Sever's Disease (Heel Pain). Read More
Fares MY, et al. (2021). Sever's Disease of the Pediatric Population: Clinical, Pathologic, and Therapeutic Considerations. Read Study
Kothari EA, et al. (2023). A Review of Pediatric Heel Pain. Read Study
Nweke TC. (2025). Conservative Management of Sever's Disease (Calcaneal Apophysitis): A Comprehensive Review of Treatment Efficacy. Read Study
American Academy of Pediatrics. Heel Pain and Sever's Disease. Read More
Smith JM and Varacallo MA (2024). Sever Disease (Calcaneal Apophysitis). StatPearls. Read More
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