Has your child just been diagnosed with Sever’s condition or are you wondering if it is really Sever’s disease after having pain in his heel after playing sports.
I will highlight some of the treatment options and answer some of your questions about high impact sports activities which are claimed to be the major course of heel pain.
I write this article based on two things.
⚫As a diagnostic radiographer, I have seen so many children in x-ray being diagnosed with Sever’s disease.so I will use my knowledge on the subject.
⚫Also based on documented research in scientific medical literature about Sever’s disease.
Happy reading!😃
Enjoy reading and feel free to ask questions in the comments or share your own experience.🙏
Last updated: April, 2025. Written by Juliet Semakula, a diagnostic radiographer.
Disclaimer Amazon affiliate links: complete disclosure in the legal notices
▶️What is Sever’s disease or calcaneal apophysitis?
Sever’s disease is a condition commonly found in children between the ages of 8 to 15 years old.
Sever’s disease is also called calcaneal apophysitis in medical terms, this is the primary cause of heel pain in children.
It occurs when the growth plate at the back of the heel, where the Achilles tendon attaches to the calcaneus bone becomes irritated or inflamed.
The red shading shows the typical areas of pain in the growth plate and heel from Sever’s disease: image Healthdirect.gov
Sever’s disease is underreported worldwide. It is often described as an overuse injury that can present with either unilateral or bilateral heel pain.
▶️What are the symptoms of Sever’s disease?
Your child will start complaining of:
🔴Pain in the heel especially after sports.it can be bilateral on only affecting only one heel.
🔴Waking up with foot stiffness or discomfort.
🔴Limping especially after high impact activities.
🔴Redness and swelling around the heel
🔴Sensitivity or pain on pressure on the heel.
▶️How is Sever’s disease diagnosed
When you go to the doctors, your doctor will perform a “squeeze test” of the heel on physical examination.
This involves pinching the heel on both sides to reveal any pain or irregular stiffness.
Also, an x-ray will be requested to rule out other problems. Usually, findings on x-ray will show increased sclerosis and fragmentation of the calcaneal apophysis.
Image of x-ray showing signs of sclerosis and fragmentation of the calcaneal apophysis on both heels showing sever’s disease (Rasuli,2019)
▶️What really causes Sever’s disease.
Here are the characteristics often but not always found in children diagnosed with Sever’s disease.
⚫First, if your child is involved in high levels of physical activities such as soccer, gymnastics, tennis and running that can cause stress to the heel.
⚫If your child is overweight, then they are more likely to have heel pain.
⚫Poorly cushioned or worn sports shoes.
⚫If your child has deformity of the lower limb, hollow foot or flat foot.
Even though the exact mechanism of injury is unknown, it is often thought is, it involves repetitive stress and pressure on the calcaneal growth plate. This is not often related to a traumatic event.
Repetitive stress can cause calcaneal inflammation around the growth plate of the heel causing pain (Fares,2021)
▶️How do you treat Sever’s disease?
Currently, there are no clinical guidelines recommending the best treatment for Sever’s disease, but previous systematic reviews have emphasized the goal of facilitating tissue healing and relieving pain.
When your doctor has confirmed that your child has sever’s disease usually you may be given therapeutic options that are used to treat Sever’s disease which are mostly conservative
Basically, the treatment of Sever’s disease is based on two things:
1️⃣Adapting the level of physical activity
2️⃣Ways to help relieve pain.
Hernandez-Lucas,2024
Here are some of the treatment options:
Resting your heel and reducing your sporting activities
Your doctor may advise you to rest your foot for at least 1 month or longer, because the pain trigger of Sever’s is increased pain especially when you are on your feet during jumping, running or any sports that puts pressure on your feet.
Walking will be possible if it does not revive the pain too much. Here in the U.k your doctor can write to the school to exempt you from school sports for some time as they assess the pain.
If your child is not bothered by the idea of completely stopping sports, then it seems suitable to stop for at least 1 month then gradually resume.
I have seen some children given a walking boot to force them to rest their leg, in such cases your child can use a wheelchair or crutches to move around.
Physical therapy may be recommended and kinesiotherapy.
Physical therapy has also proven to be beneficial for heel pain specifically in treating Sever’s condition.
Physiotherapy sessions are sometimes prescribed, here are some practices widely used.
Specific stretches and massages,
Application of physical therapy such as specific stretches and massages, can lead to a significant decrease in pain and improved ankle functionality in patients with Sever’s disease.
Hernandez-Lucas,2024
Kinesiotherapy, shock waves, cryotherapy,
Kinesio tape has also been explored as an intervention in treating Sever’s disease. Some studies say it may have benefits in improving ankle dorsiflexion.
The application of Kinesio tape could be considered as part of a comprehensive treatment strategy to address dorsiflexion limitations and reduce pain in patients with Sever’s condition
Hernandez-Lucas,2024
Sole, headpiece and splints
The use of foot orthoses and heel cushions in the footwear.
In a few studies, foot orthoses and heel cushions are often considered the most effective methods for reducing pain scores and an increase in ankle functionality.
Insoles provide cushioning and therefore reduce the impact force on the calcaneus during heel strike.
A clinical trial comparing the effectiveness of inserts and footwear for persons with calcaneal apophysitis found that two inserts were associated with improved pain scores (Uvelli,2017)
Some patients claimed to have had equal improvement by three months with or without therapy just by wearing heel cushions and foot orthoses.
In practice if you want to test some of these foot orthoses, opt first for the easiest thing to test and see if they work for you, a simple standard heel cup or sole bought in any sports shop or on the internet (see an example on Amazon).
Applying ice tubes to the heel
Apply Ice tubes on the affected area to help with cooling the pain and inflammation.
Apply ice for 10-15 minutes at a time, several times a day, but not directly to the skin. Wrap the ice in a towel or cloth first.
▶️What exercises may be helpful for Sever’s disease pain.
Performing exercises and stretches before and after sports activities has been helpful to relieve pain.
Types of stretches:
1️⃣Gastrocnemius Stretch
Attached above the knee, the gastrocnemius muscle allows the knee, ankle, and foot to flex at each of their joints.
To perform this stretch:
♦️Find a wall to help with balance.
♦️Keep the heel grounded while slowly leaning and pushing forward towards the wall.
♦️Hold the position for up to 45 seconds.
2️⃣Soleus Stretch
This stretch is designed to exclusively stretch the soleus muscle located behind the calf in the lower leg. It will isolate and stretch this specific muscle without stretching several others all at once.
To perform this stretch:
♦️Stand facing a wall about three feet away.
♦️Step forward with the right foot.
♦️Place both hands on the wall.
♦️Lean forward while bending both knees.
♦️Hold for up to 60 seconds.
♦️Relax, switch legs, and repeat.
3️⃣Heel Dips
Heel dips are a popular stretch designed to stretch the calf and help alleviate pain associated with both Sever’s disease and plantar fasciitis.
To perform this stretch:
♦️Stand on a step (preferably the bottom one).
♦️Grip the handrail for balance and safety if any.
♦️Slide the feet backwards so the heels are hanging and only the toes are on the step.
♦️Gently drop the heels down until the calf muscle is stretched.
♦️Hold the stretch for 10 seconds and repeat five times.
4️⃣Towel Stretch
The towel stretch obviously involves the use of a towel. Unlike the other more targeted stretches, it stretches the foot, heel, calf, hamstrings, and lower back as well.
To perform this stretch:
♦️Sit down on a hard surface with the legs outstretched straight ahead.
♦️Keep your knees straight.
♦️Loosely roll a towel lengthwise, grab the ends, and loop it around the balls of both feet.
♦️Pull the towel and toes toward the body.
♦️Hold the position for 30 seconds.
♦️Repeat three times.
5️⃣Seated Calf Stretch
This stretching exercise is like the towel stretch, except it involves a chair and an elastic band.
To perform this stretch:
♦️Sit on a chair.
♦️Place an elastic band around the balls of both feet.
♦️Keeping a straight back, pull the elastic band so the toes point towards the shinbone.
♦️Hold the position for 30 seconds.
♦️Repeat up to five times.
7️⃣Wall Calf Stretch
The wall calf stretch is a variation of the soleus stretch.
To perform this stretch:
♦️Stand facing a wall.
♦️Slowly lean forward and place both hands on the wall.
♦️Bend one knee and stretch out the other leg straight behind you.
♦️Make sure to keep the stretched leg straight.
♦️Hold the stretch for 30 seconds.
♦️Switch to the other leg and repeat 10 times.
Hernandez-Lucas.2024
There are so many types of stretches your physio or doctor may recommend helping with Sever’s pain. These are just a few of these.
▶️Disadvantages of stretching
🟣However, there were no clinical trials that show that children who practice regularly have less pain, or they can resume sports as they wish more quickly.
🟣These stretches can be difficult for children.
🟣Stretching can also lead to renewed stress and inflammation on the heel.
Medications
🟤Your doctor may prescribe medications such as nonsteroidal anti-inflammatory drugs.
🟤Immobilization.
🟤Wear well-fitting, good quality shoes with shock absorbent soles to minimize heel pressure. Some people use heel cups in the shoes to help with pain caused by Sever’s.
Ramponi,2019
No long-term effects have been associated with Sever’s disease.
▶️What are good exercises for Sever’s disease?
It will depend on what you mean by good. There are so many stretch exercises for Sever’s disease, but it will depend on what works for you to ease the pain and discomfort.
As discussed above here is a you tube video by DR travis Owens of Airrosti rehab centre: Mobility Exercises & Stretches for Sever’s Disease (Calcaneal Apophysitis)
There are no studies available that would allow us to recommend one of these approaches, or even physical therapy versus doing nothing.
So always consult your doctor before engaging in any exercises because some of the movements may increase your pain instead of reducing it.
You need a full examination to determine which ones are good for your situation
▶️Can my child still play sports with Sever’s disease?
Yes, your child can still participate in certain sports that do not require high impact to the heel.
Here are the least restrictions sports for Sever’s disease.
🟢Swimming
🟢Cycling and mountain biking.
🟢Riding a bicycle
🟢Rowing and kayaking.
Here are the most restrictive:
🔴All sports that involve high impact to the heel such as soccer, volleyball, and basketball.
🔴Gymnastics
🔴Trampoline
The truth is there is no sport that is absolutely forbidden, it very much will depend on the doctors you come across, your child’s pain and the approach you want to take.
▶️How long does the pain or discomfort last?
When children are growing, the bones, muscles and tendons grow at different rates.
The Achilles tendon joins the calf muscle to the heel bone (calcaneus).
Pain occurs when this area of attachment is still growing, where cartilage is changing to bone and there is a physical stress in this area, it causes inflammation and pain, called Severs
The question is how long can this pain last?
There are many different advancements, and no reliable data on the average duration of pain and discomfort in children with Sever’s disease
But if your child has only a single painful attack leading to pain during sports then.
Sever’s disease pain typically will subsides within a few weeks to months with proper care, usually 2 to 8 weeks.
However, some individuals may experience continuous pain and symptoms which may last for 12 to 24 months, and in some cases, the condition can last until the growth plates mature.
Chances your child will fall somewhere between these 2 extremes
Nevertheless, even in the worst case, the pain will eventually disappear at the end of the growth plate around the age of 15 or even earlier.
▶️Are there any possible complications
There are few complications described in the scientific studies and patients whose children are concerned.
🔴Pain at the foot complex region.
🔴Plantar fasciitis.
🔴Bone infection (osteomyelitis)
Once the condition resolves, it generally doesn’t lead to any lasting problems or permanent damage to the heel bone.
We have no empirical evidence to suggest that continuing sport or physical activity puts you at greater risk of developing any of these complications.
Conclusion: Full recovery of the Sever’s disease is expected after closure of the calcaneal apophysis.
Conservative interventions, such as the use of insoles, physical therapy, and Kinesio taping, seem to have a positive effect in reducing pain and improving functionality in patients with Sever’s disease.
We have come to the end of this article; any experience or questions let’s meet in the comments sections
Wishing you a quick recovery!🙋
📚Sources:
Ramponi DR, Baker C. Sever’s Disease (Calcaneal Apophysitis). Adv Emerg Nurs J. 2019 Jan/Mar;41(1):10-14. doi: 10.1097/TME.0000000000000219. PMID: 30702528.
Fares MY, Salhab HA, Khachfe HH, Fares J, Haidar R, Musharrafieh U. Sever’s Disease of the Pediatric Population: Clinical, Pathologic, and Therapeutic Considerations. Clin Med Res. 2021 Sep;19(3):132-137. doi: 10.3121/cmr.2021.1639. PMID: 34531270; PMCID: PMC8445662.
Hernandez-Lucas P, Leirós-Rodríguez R, García-Liñeira J, Diez-Buil H. Conservative Treatment of Sever’s Disease: A Systematic Review. J Clin Med. 2024 Feb 28;13(5):1391. doi: 10.3390/jcm13051391. PMID: 38592198; PMCID: PMC10932217.
Uvelli K, Neher JO, Safranek S. Treatment for Calcaneal Apophysitis. Am Fam Physician. 2017 Jul 15;96(2):126-127. PMID: 28762709.
Rasuli B, Sever disease. Case study, Radiopaedia.org (Accessed on 12 Apr 2025) https://doi.org/10.53347/rID-65420
Image 1: https://www.healthdirect.gov.au/severs-disease
Images : https://apps.nhslothian.scot/files/sites/2/RHCYP-Severs-Disease-V4.1.pdf