Sever's Disease (childhood heel pain)

In summary: heel pain in athletic children aged 8-13 is almost always Sever’s disease: an irritation of the growth plate. It is benign, resolves on its own when the heel has finished growing, and in the meantime, sport can be continued with a well-managed load.

Sever’s disease (calcaneal apophysitis) is the most common cause of heel pain in active children and prepubescents. The name may sound alarming, but the reality is reassuring: it is not a disease in the usual sense, but rather an overload of the heel’s growth area, which at this age is still soft cartilage.

The pattern is highly characteristic: a boy or girl aged 8 to 13, participating in impact sports several times a week, with pain that appears during activity and improves with rest. They often limp at the end of a match but feel fine the next day. It can affect one foot or both, and the intensity can vary depending on training load, footwear, and the growth phase.

Why it happens right now

During the growth spurt, bone grows faster than muscles and tendons. The result: a relatively tight Achilles tendon pulling on a growth area that is still soft, hundreds of times per training session. If we add to this hard surfaces, studded boots, or a gait that loads the heel poorly, the area becomes irritated.

It is not usually the result of a single movement or a severe injury. It typically appears gradually, especially when training increases, the surface changes, or more than one sport is combined. It can also coincide with a temporary limitation in the flexibility of the calf muscles and the Achilles tendon.

Therefore, the treatment is not to “stop everything and wait”, but rather to distribute loads better: a heel raise or insole to provide cushioning, assessing the gait if there is a predisposing foot type, gentle calf stretches, and a realistic sport plan — which is the part that families (and coaches) appreciate the most.

How it is diagnosed

The diagnosis is primarily clinical. During the consultation, we will ask when the pain started, what activities trigger it, whether it improves with rest, and if there has been any trauma. It is also useful to know what footwear is used, how many hours are spent training, and whether the pain interferes with walking or daily activities.

During the examination, we assess exactly where it hurts, ankle mobility, the tension in the calf muscles and Achilles tendon, the way the child walks, and the alignment of the foot and leg. We also compare both sides and look for signs pointing to another cause.

In many cases, no imaging tests are required. If the clinical picture is not typical, the pain is severe or persistent, there is a history of trauma, or the examination indicates it, we may request an X-ray. Ultrasound can be useful in specific situations, and a gait analysis is reserved for assessing whether foot mechanics are contributing to the symptoms.

Yes to sport, but well-dosed

Our priority with athletic children is that they do not lose an entire season due to Sever’s disease. At the sports podiatry clinic, we plan how much they can train, what needs to be reduced (impact, hard surfaces), and how to return when the pain eases. Pain is the compass: if a load adjustment controls it, nothing else is needed.

Not all training sessions need to be modified in the same way. Sometimes adapted activity can be maintained, temporarily avoiding jumps, sprints, or intense matches. It is important to coordinate the plan with the family and the coach, without forcing the child to play in pain or imposing unnecessary immobilisation.

Treatment options

The first step is to temporarily reduce activities that cause pain, while maintaining movement that is well tolerated. Local cold application after activity can relieve discomfort in some cases. We also review footwear and propose gentle mobility and flexibility exercises, always tailored to the child’s age and examination findings.

A heel raise can reduce tension and impact on the heel. If we detect a gait abnormality or a specific mechanical need, we may consider an insole. Not all children need one, and the goal is not to correct an image, but to reduce symptoms and facilitate more comfortable loading.

Surgery is not part of the standard treatment for Sever’s disease. Other options would only need to be explored if the diagnosis is unclear or if there is another associated injury. Improvement usually occurs gradually, and there may be periods of discomfort while growth continues.

And a reassurance for families: Sever’s disease leaves no sequelae. Once the cartilage closes, the pain disappears. Our aim is to make the journey to that point as comfortable as possible.

When to suspect it is NOT Sever’s disease

If the child is under 7 years old or over 14-15, if the pain occurs at night or during absolute rest, if there is visible swelling or fever, or if it started with a severe impact, the clinical picture changes and requires a more thorough examination. This also applies if the pain is in another area: a symptomatic flat foot or an unusual gait warrant their own assessment.

Also seek consultation if the pain worsens despite reducing the load, prevents normal walking, occurs repeatedly, or does not follow the usual pattern of activity and rest. A proper examination allows us to confirm whether it is Sever’s disease and to rule out problems with the tendon, bone, joints, or skin.