Sever's Disease (Heel Pain in Growing Children)

Overview

Sever's disease (calcaneal apophysitis) is one of the most common causes of heel pain in children. Despite the name, it is not a disease. At the back of the heel bone there is a growth plate — an area of developing bone where the Achilles tendon attaches. During growth spurts the bones can grow faster than the muscles and tendons, so a tight calf and Achilles pull harder on this growth plate. With repeated running and jumping, the area becomes irritated and sore.

It usually affects active children between about 8 and 14 years old, often a little younger in girls than boys, and is especially common in football, running, gymnastics, basketball and dance. Children typically complain of pain at the back or sides of the heel during or after sport, and may limp or walk on their toes after training. Often both heels are affected.

The reassuring news is that Sever's disease usually settles once the growth plate matures and fuses, typically by the mid-teens, although how long this takes varies from child to child. The aim of care is to manage symptoms and keep your child active and enjoying sport — it rarely means stopping sport altogether.

Causes and risk factors

• Growth spurts, when bones lengthen faster than muscles and tendons
• Tight calf muscles and Achilles tendon
• A lot of running and jumping, especially on hard surfaces or artificial pitches
• Playing several sports or training sessions a week, or the start of a new season
• Flat feet or overpronation
• Worn or unsupportive footwear, including football boots with little heel cushioning
• Being overweight, which increases load on the heel

How we may be able to help

Assessment first, with a parent or guardian present. We take a full history, gently squeeze the heel to check for the typical tenderness, assess calf flexibility, foot posture and training load, and make sure there is no sign of another cause of heel pain such as a fracture or infection.

Physiotherapy focuses on explaining the condition to your child and to you, adjusting training so that sport can continue at a level the heel tolerates, improving calf flexibility, and age-appropriate strengthening, followed by a gradual return to full activity. Our 3D foot scan can show whether foot posture is adding to the strain; heel raises, cushioned insoles or custom orthotics may then help reduce the pull on the growth plate. Kinesiology taping can add comfort during sport.

We keep care for growing children gentle and conservative: we do not use focused shockwave, dry needling, electrotherapy or injections for Sever's disease.

What you can do at home

• Use a wrapped ice pack on the heel for 10 minutes after sport
• Try gel heel cups or heel raises in school shoes, trainers and football boots
• Do gentle calf stretches every day, holding each for about 30 seconds
• During a flare, swap some high-impact sessions for swimming or cycling
• Wear supportive, cushioned trainers and avoid running barefoot on hard surfaces
• Aim for sport to cause only mild discomfort that has settled by the next morning