Sever’s Disease: A Parent’s Guide from a Foot and Ankle Surgeon
Heel pain is common in growing kids. The most frequent reason is something called Sever’s disease. The name sounds scary. It is not a true disease. It is temporary irritation at the heel growth plate during growth spurts. The medical name is calcaneal apophysitis, which means inflammation of the heel’s developing bone where the Achilles tendon attaches.¹² Most kids improve with a simple plan and return to full activity within four to eight weeks.³
Parent takeaway: Your child is safe. This is an overuse irritation of a still growing heel. With smart changes and simple inserts most kids feel better quickly.¹²³
Related reading:
• Pediatric Flatfoot: What Parents Need to Know
What Parents Need to Know First
Sever’s disease is not permanent. It settles as the growth plate matures and closes. That usually happens by age fourteen to fifteen.¹ The goal is comfort, steady progress, and safe activity until the growth plate finishes developing.¹²
Who Gets Sever’s Disease
| Condition | Typical Clues | What Parents Notice |
|---|---|---|
| Sever’s Disease (calcaneal apophysitis) |
Ages 8-15, pain during or after sport, sore to heel squeeze, tight calves common | Limp during play, tip-toeing to avoid heel strike, pain improves with rest |
| Plantar Fasciitis | Morning start-up pain, rare before adulthood | First-step pain in adults, rarely primary cause in children |
| Calcaneal Stress Fracture | Constant pain, hop test painful, swelling may appear | Pain even with walking, recent big jump in activity |
| Achilles Tendinopathy | Pain along tendon rather than heel bone, often older teens | Tender when squeezing tendon itself |
What It Looks Like At Home
Parents often notice pain during or after practice, a limp that appears mid session, toe walking to avoid heel contact, and pain relief with rest. The sides of the heel are sore when you squeeze them. A tight calf is common and can keep pulling at the growth plate.³⁴
Why it hurts: The heel bone grows faster than the calf muscle and Achilles tendon during a growth spurt. That creates extra tension at the growth plate with running and jumping. Repeated loading irritates the area and causes pain.¹²
How I Diagnose It In Clinic
I start with the story of when the pain shows up. Then I examine the heel.
Heel squeeze test: Gentle squeeze of the heel edges reproduces the pain.³
Calf and ankle check: Limited ankle motion and tight calves are common.³⁴
Gait: I look for toe walking or a painful limp.
Shoes: I check the heel counter and midsole wear.
Imaging is not routine. I consider X-rays if pain is severe on only one side, there is a history of trauma, fever or night pain is present, or there is no improvement after three to four weeks of good care.⁴¹¹¹²
Things we need to rule out when the story is not typical: Calcaneal stress fracture, infection, bone tumor, tarsal coalition, and Achilles tendinopathy.⁴
Evidence Based Treatment Protocol
Research supports a simple plan that blends activity changes with in shoe support and gentle mobility. This works better than rest alone.¹²
First line care for the first two to four weeks
Activity modification
Stay active with pain free activities like swimming or biking. Reduce running and jumping until walking, hopping, and short jogs are comfortable. Pain should not increase during the activity, after the activity, or the next morning. Progress by function, not by the calendar.⁸
Inserts that help the heel
Deep heel cups reduce shear at the growth plate. A randomized crossover trial showed better pain relief and function compared with simple wedges.²
Heel lifts decrease Achilles pull by reducing the amount of ankle bend needed during gait. Adding a lift with exercise improved outcomes at two months.⁶
Prefabricated orthoses with a deep heel cup can reduce pain and support the foot. A randomized trial and systematic reviews show benefit.¹²⁸
Custom orthoses are reserved for tougher, recurrent cases or clear biomechanical issues such as significant flatfoot or an equinus contracture (overly tight achilles tendons).⁴
Footwear tune up
Choose a supportive athletic shoe with a firm heel counter and quality cushioning under the heel. Replace shoes when the heel counter gets soft or the tread is worn out.¹²
Mobility and strength
Gentle calf stretching two to three times a day works well. Hold for thirty seconds and repeat. Add progressive calf strengthening as pain settles so the tendon and muscle handle sport loads better.³⁴
Short term protection only if needed
If walking is painful or there is a clear limp, a walking boot for one to two weeks can calm the flare. Then we wean into a heel cup or heel lift and a simple home program. Prolonged immobilization is not helpful for most kids.⁴
Return To Sport The Right Way
Most kids return to mostly fully activity and sport in four to eight weeks once daily walking is pain free and they can hop and jog without a limp. A youth soccer cohort reported an average full return near eight weeks. Recurrence is more likely if the return is rushed.⁷
I use a kid friendly checklist based on the PAASS framework.⁸
Pain is quiet. Ankle function is normal. Athlete confidence is good. Balance and control look steady. Sport tasks like short sprints, cutting, and jumps are pain free and look normal.
Quick timeline
Days one to fourteen: reduce running and jumping, start heel cups or heel lifts, begin gentle calf stretches.
Weeks two to four: add short jog intervals and simple drills if pain free.
Weeks four to eight: full practice, then games when hop and sprint tests are pain free and movement looks normal.⁷⁸
| Phase | Goals Before Moving On | Typical Timeframe |
|---|---|---|
| 1. Pain-Free Daily Activity | Walk without limp, climb stairs comfortably, no morning stiffness | Weeks 1-2 |
| 2. Running Progression | Single-leg heel raises pain free, short jogs on level ground tolerated | Weeks 3-5 |
| 3. Sport-Specific Drills | Full practice tolerated, cutting and jumping mechanics normal | Weeks 6-8 |
| 4. Return to Competition | One full week of unrestricted practice, player confident, pain free | Variable |
What Not To Do
Do not push through pain that changes your child’s movement. That slows recovery.⁴
Do not immobilize for many weeks unless there is a fracture or a very severe flare.⁴
Do not ignore worn out or unsupportive shoes. Footwear matters in this condition.¹²
Prevention While Your Child Is Still Growing
Increase training volume slowly. Avoid sudden spikes in running and jumping.⁷
Keep a short daily calf stretch during growth spurts.³
Use supportive athletic shoes and replace them regularly. Consider a heel cup during heavy training phases for kids who flare.¹²²
When To See A Specialist
| Red Flag Symptom | Why It Matters |
|---|---|
| Night pain or pain at rest | May indicate infection or bone tumor rather than growth-plate irritation |
| Swelling, redness, or warmth | Could signal infection or fracture |
| Limp lasting longer than two weeks | Suggests need for imaging or different diagnosis |
| History of fall or jump with sudden pain | Possible fracture—needs evaluation before continuing sport |
Not sure if it is heel pain or an ankle sprain
See our ankle sprain guide
Common Parent Questions
❓ Frequently Asked Questions
Will Sever’s disease cause permanent damage?
No. Sever’s disease resolves completely once the heel growth plate closes. There are no long-term effects on bone or movement.³
Can my child keep playing sports?
Yes, if play does not cause limping or change how your child moves. Most kids can continue with modified practice while symptoms settle. Use the pain-monitoring rule—if pain lingers or worsens after play, scale back.⁸
How long does it take to get better?
Most kids improve within four to eight weeks after starting care. Some may have mild flares during later growth spurts.⁷
Do we need X-rays?
Usually not. Imaging is only needed if pain is one-sided, severe, or linked to trauma, fever, or swelling.⁴¹¹¹²
Are custom orthotics necessary?
Not at first. Begin with over-the-counter heel cups or prefabricated orthoses. Custom devices help only when pain persists or foot mechanics are more complex.²⁶⁸
References
¹ American Academy of Orthopaedic Surgeons. Sever’s Disease. OrthoInfo. 2024.
² James AM, Williams CM, Haines TP. Effectiveness of interventions for calcaneal apophysitis. J Foot Ankle Res. 2013.
³ Smith JM. Sever Disease. StatPearls. 2024.
⁴ Kothari EA. Pediatric heel pain and differential diagnosis. 2023.
⁵ Perhamre S, et al. Treat Sever’s injury with a heel cup. Randomized crossover study. Scand J Med Sci Sports. 2011.
⁶ Wiegerinck JI, et al. Heel raise versus exercise versus wait and see. Br J Sports Med. 2016.
⁷ Belikan P, et al. Long term clinical outcome and return to play in youth with Sever’s disease. Foot Ankle Surg. 2022.
⁸ Dubois B, et al. PEACE and LOVE for soft tissue injuries. Br J Sports Med. 2020.
⁹ James AM, et al. Footwear and foot orthoses trial for calcaneal apophysitis. Br J Sports Med. 2016.
¹⁰ Smith MD, et al. The PAASS framework for return to sport. Br J Sports Med. 2021.
¹¹ Rachel JN, et al. Is radiographic evaluation necessary in children with clinical Sever disease. J Pediatr Orthop. 2011.
¹² Kose O. Do we need radiographs for non specific heel pain in children. Skeletal Radiol. 2010
