Sever’s disease, also known as Calcaneal apophysitis, is the most common cause of heel pain in children and adolescents.

Sever’s disease is an overuse injury that occurs when there is inflammation of the growth plate in the heel bone. This is the same area that the Achilles tendon attaches, which in adolescents is cartilage. Whilst we grow into puberty, the cartilage attachment transitions into a tendon-bone attachment. This area is weaker as we grow which means with poorer mechanics and increasing levels of sports activities it can become easily overloaded.

Factors that may contribute to Sever’s disease include:

    • Typically it affects children between the ages of 8 and 14. 
    • Males are more likely to be affected by Sever’s than females. 
    • Those that are involved in running and jumping are more likely to be affected. 
    • How much physical activity a child is doing. Often an increase in volume, intensity or frequency of activity will increase risk.
    • Height and weight – growing at a rapid weight will increase chance of inflammation at the growth plate

When looking out for risk factors the Podiatrist will consider:

  • Whether there has been a crossover in sports (eg from Summer to Winter and an increased load during this period)
  • When the volume increases at the start of a season coming from off season or holidays
  • If there was a tournament with an increased load dramatically
  • The surface the activities are undertaken and type of activity
  • Equipment or external factors such as a change of shoes with a lower heel. Or whether the activities are undertaken barefoot, on the beach etc.

Symptoms of Sever’s disease include:

  1. Pain at the back of the heel usually when participating in an activity
  2. Swelling and tenderness in the heel
  3. Difficulty walking or running, may have a tendency to tip-toe
  4. Can have some stiffness in the heel when waking up in the mornings

Management of calcaneal apophysitis:

  • Reducing activity levels and in some cases rest. It is important to reduce activities that aggravate the condition until symptoms have resolved.
  • Icing the heel after activity for 10 to 15 minutes
  • Anti-inflammatories such as ibuprofen may help reduce pain and inflammation at the time
  • Heel lifts to reduce stress on the growth plate
  • An assessment of appropriate footwear 
  • Improve the mechanics of the leg ensuring reduced overload. This may include a strength program (calf in particular), heel raises, changes to shoes or boots. A Podiatrist will assess running and walking mechanics. 

In most cases, symptoms will resolve within a few weeks to months with appropriate management. If not managed appropriately, sever’s can lead to chronic heel pain and other issues. 

Podiatrist assessing a child's sever's disease

Other causes of heel pain:

The Podiatrist will determine whether there is potentially another cause of the heel pain through a thorough assessment. Other causes of heel pain in pre-teens include:

  • Bursitis – this occurs when the bursae that lubricates the joint and muscle is irritated. Common causes are from overuse, tight shoes and injury.
  • Posterior ankle impingement (not common for this age group) – can occur after an ankle sprain
  • Stress fracture (also not common for this age group) – occurs when there is too much loading on the bone
  • Heel fracture – often occurs from a fall from height directly onto the heel
  • Juvenile rheumatoid arthritis – causes swelling and stiffness leaving persistent joint pain

Our Podiatrists will assess and find the most appropriate management for Sever’s and ensure you are back on the field in no time. 

Ready to meet the team?

You can find out about our specialist podiatry services designed to keep our community moving here.

Ready to make an appointment?

Use our convenient online booking system to quickly secure your preferred appointment date and time.