Quick Summary
Sever's disease (calcaneal apophysitis) is the most common cause of heel pain in active children and teenagers. It develops when the growth plate at the back of the heel becomes irritated by repeated pulling from the Achilles tendon during a growth spurt — typically between ages 8 and 15. It is self-limiting and settles once the growth plate matures. Our physiotherapists use hands-on manual therapy, load management and targeted exercises specifically suited to a growing child, and most young patients notice meaningful improvement within 4–8 sessions.
What Is Sever's Disease?
Sever's disease — known medically as calcaneal apophysitis — is an overuse injury of the growth plate at the back of the heel bone. It was first described by James Warren Sever in 1912 and remains the most frequent cause of heel pain in children and adolescents.
The calcaneal apophysis is a separate centre of bone growth that appears at around age 7 to 9 and fuses with the main heel bone between roughly 15 and 17 years of age. The Achilles tendon attaches directly onto this growth centre. During a growth spurt, the heel bone lengthens faster than the calf muscles and Achilles tendon can adapt, so the relatively tight muscle-tendon unit places increased traction across a growth plate that is still partly cartilage. Repeated running and jumping then produces microtrauma, irritation and bone swelling at that site.
Research suggests the condition is common in the general child population and in youth sport. A Dutch primary care study identified an incidence of 3.7 per 1,000 registered patients aged 6 to 17 (Wiegerinck et al., European Journal of Pediatrics, 2014), while a ten-year review of a German youth football academy recorded a mean return to play of around 61 days, with bilateral cases taking considerably longer than one-sided cases (Belikan et al., Journal of Orthopaedic Surgery and Research, 2022).
The reassuring news for parents is that Sever's disease is self-limiting. Because it relates to an open growth plate, symptoms resolve once that growth plate fuses in the mid-teens, and evidence shows it does not cause lasting damage to the heel. Diagnosis is made clinically — most often by gently squeezing the sides of the heel, which reproduces the pain — and scans are used only to rule out other causes. Flare-ups may recur during growth, so the aim of treatment is to control symptoms and keep your child active while the skeleton matures.
Do You Experience These Symptoms?
✓ Gradual onset of heel pain that builds during or after running and jumping, and settles with rest
✓ Limping, tiptoe walking or reduced running speed after sport as your child tries to take weight off the heel
✓ Tenderness when the sides of the back of the heel are gently squeezed — one of the most characteristic signs
✓ Pain that is worse on hard surfaces such as astroturf or indoor courts, or in flat and studded football boots with little heel cushioning
✓ Tight calf muscles and difficulty pulling the foot upwards towards the shin
✓ Stiffness in the heel first thing in the morning or after sitting, which often eases on warming up and returns after cooling down
✓ Pain in both heels in a large proportion of cases, rather than just one side
These symptoms can be treated.
The sooner you begin, the better your chances of a smoother recovery.
What Causes Sever's Disease?
• Growth spurt and bone-to-muscle mismatch
The heel bone lengthens more quickly than the calf muscles and Achilles tendon can lengthen to match it during rapid growth.
This leaves the growth plate under increased traction at exactly the age when it is least able to tolerate repeated load.
• Repetitive impact sport and rapid increases in training load
Football, rugby, netball, basketball, running, gymnastics and dance all involve repeated heel strike and push-off through the Achilles tendon.
Symptoms very often begin after a sudden rise in training volume, such as the start of a new season, a tournament week or a change of club.
• Reduced ankle movement and calf tightness
Limited ability to bring the foot upwards towards the shin is the risk factor most consistently identified in systematic review (Nieto-Gil et al., BMJ Open, 2023).
A tight gastrocnemius and soleus complex increases the pull transmitted through the Achilles tendon onto the growth plate.
• Footwear and playing surface
Flat, worn or unsupportive shoes and studded boots offer very little shock absorption under the heel.
Hard and artificial surfaces increase the impact travelling through the heel with every stride.
• Foot posture and body weight
Flat feet, high arches and raised pressure under the heel have all been associated with the condition, although the evidence remains mixed.
A higher body mass index increases the load passing through the growing heel during running and landing.
How We Treat Sever's Disease at J&J Therapy
Hands-On Manual Therapy
Hands-on treatment from our HCPC-registered physiotherapists to release tightness in the calf and Achilles complex, mobilise the ankle and subtalar joints, and restore comfortable movement. Gentle, age-appropriate techniques suited to a growing child.
Shockwave Therapy*
For conditions involving open growth plates in young patients, our care emphasises specialised manual therapy and targeted exercises — the most appropriate approach for your specific needs.
Targeted Exercise Programme
A progressive programme built around your child's sport: calf stretching, graded heel-raise strengthening, and a structured load-management and return-to-play plan, alongside footwear advice and heel cushioning where helpful.
When to Seek Urgent Medical Help
While most symptoms are not serious, urgent medical attention is required if you experience any of the following:
Heel pain at night or at rest that is unrelated to activity, or that wakes your child from sleep
Fever, feeling generally unwell, or unexplained weight loss alongside the heel pain
Marked swelling, redness or warmth around the heel or ankle
Inability to put weight through the foot after a fall or injury, or one-sided pain that does not improve with conservative care
FAQs About Sever's Disease
How long does Sever's disease last?
Most children settle within a few weeks to a couple of months once training load is managed and treatment begins. Research from a youth football academy reported a mean return to sport of around 61 days, although recovery times varied widely and cases affecting both heels took considerably longer. Flare-ups may return during growth spurts, but the condition resolves for good once the growth plate fuses in the mid-teens.
Can my child keep playing sport?
In most cases yes, at a level guided by symptoms. Complete rest is rarely necessary or helpful. We work with you to reduce the most painful high-impact activities for a period, keep fitness up through swimming or cycling, and then rebuild running and jumping gradually so your child returns to their sport safely.
Will it cause permanent damage to my child's heel?
Evidence shows that Sever's disease is self-limiting and does not lead to long-term damage or deformity. The growth plate matures normally and symptoms stop once it fuses. The purpose of treatment is to control pain and keep your child active and enjoying sport in the meantime.
Does my child need an X-ray or a scan?
Usually not. The diagnosis is made clinically from the history and examination, particularly a positive heel squeeze test. Imaging is reserved for ruling out other causes of heel pain such as a stress fracture, a tarsal coalition or an inflammatory condition, and our physiotherapists will advise you if onward referral is appropriate.
Why do you not use shockwave therapy for Sever's disease?
Because children with this condition have an open growth plate in exactly the area that shockwave therapy would target. International guidance from the International Society for Medical Shockwave Treatment and the manufacturer instructions for our Swiss Storz Medical MASTERPULS device both identify growth plate areas in children as a contraindication. We therefore do not offer shockwave therapy for Sever's disease. Manual therapy, load management and targeted exercise are the appropriate and effective approach for a growing child.
This page is for general information only and does not replace professional medical advice.
Reviewed by Lavya Arigalayan, MSc, HCPC Registered Physiotherapist.
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