Sever's Disease in Children
Symptoms, Causes and Treatment of Sever's Disease and Related Heel Pain
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Is it growing pains or
sever's Disease?
Sever’s condition, also called “calcaneal apophysitis”—is the most common cause of heel pain in active children ages 6–14. Sever’s happens when the heel’s growth plate becomes irritated from sports, running, rapid growth and even injury. At Pediatric Foot & Ankle, we diagnose Sever’s disease every day. This page breaks down the signs, symptoms, acute vs chronic; How they differ and when it’s time to call us, the experts!
It is important to note that acute and chronic Sever’s are not treated the same, and both have different approaches for the best resolution.
Trusted Pediatric Foot & Ankle Care • Thousands of children treated by Dr. Mikkel Jarman, DPM, FACFAS
What is sever's Disease?
Sever’s condition, also called “calcaneal apophysitis”—is the most common cause of heel pain in active children ages 6–14. Sever’s happens when the heel’s growth plate becomes irritated from sports, running, rapid growth and even injury. At Pediatric Foot & Ankle, we diagnose Sever’s disease every day. This page breaks down the signs, symptoms, acute vs chronic; How they differ and when it’s time to call us, the experts!
It is important to note that acute and chronic Sever’s are not treated the same, and both have different approaches for the best resolution.
Causes & Symptoms
What complicates severs?
- Rapid growth spurts (Ages 6-14).
- High-Impact sports ( Soccer, Running, Gymnastics, Dance).
- Flat feet, high arches, or pronated feet.
- Tight Achilles Tendon.
- Extra weight increasing heel pressure.
- Leg length differences.
- Increased sports activity
- Hard playing surfaces
- Unsupportive shoes or cleats
Plantar Fasciitis vs Sever's Syndrome
Children’s heel pain is different than adult heel pain and must be treated differently.
Pediatric heel pain is differs significantly from adult presentations and requires a distince treatment approach. True plantar fasciitis is exceptionally rare in children; Irritation of the calcaneal apophysis (growth plate) occurs well before the plantar fascia becomes involved. As a result, management protocols designed for plantar fasciitis are typically ineffective for pediatric patients and yield minimal clinical improvement.
Symptoms of severs
Common Symptoms
- Pain localized to the back and sides of the heel.
- Pain that worsens with activity (especially running/jumping) and improves with rest.
- Children seem to constantly walk on the outside of their feet or rock to the ball of their feet
- Pain that may cause limping or walking on tiptoes to avoid heel strike.
- Tenderness when the doctor squeezes the heel (the “squeeze test”).
- Often affects both heels (bilateral), but one side may be worse.
Clinical Diagnosis
- The diagnosis is primarily clinical (based on history and physical exam).
- X-rays cannot diagnose severs: X-rays are typically normal for Sever’s and are used to rule out other serious conditions (like a fracture, stress fracture, or bone cyst, coalitions, or altered anatomy).
- However, in severe cases of severs there can be radiographic signs of bone activity around the growth plate called fissuring.
Accute vs chronic - Why It matters?
Sever’s disease may present acutely or chronically & identifying the correct form is key to effective treatment. Misdiagnosis is common.
acute vs chronic treatment
While both types of Sever’s condition aim to reduce pain and decrease pressure on the heel growth plate, the treatment intensity is very different. Acute Sever’s responds well to basic home care, while Chronic Sever’s requires structured, specialist-guided treatment such as the Mikki Device™.
| Feature | Acute Sever's Condition | Chronic Sever's Condition |
|---|---|---|
Onset of Pain | Sudden flare-up, often linked to a recent increase in activity (e.g., starting a new sports season). | Ongoing, persistent pain that has been present for several weeks, months or sometimes years. |
Squeeze Test | Mild response and only present immediately after the activity for 1-2 hours. | Strong response and present when the child wakes up to when they go to bed. |
Severity of Pain | Typically milder; a child may limp only after activity Pain is intermittent. | More severe; pain is often constant, affecting the child even when they are not active. May lead to a pronounced limp or consistent altered gait, mostly due to compensation. |
Response to Rest | Responds very well to a few days of rest, ice, NSAID’s and basic over-the-counter (OTC) heel cups. | Does NOT fully resolve with simple rest, ice, NSAID’s. Pain quickly returns upon resuming activity. |
Underlying Issue | A temporary inflammatory flare-up of the growth plate due to an isolated event or rapid load change. | Indicates a deeper bone growth plate injury, uncorrected biomechanical issue. |
| Need for Specialist | Generally, it does not require specialist care; it can be managed at home. The condition resolves in days. | Requires specialist care (comprehensive assessment and customized treatment) Mikki Device Orthotic management |
Acute Sever's Condition
Short term flare up
Goal: Calm inflammation quickly and return the child to activity safely.
Recommended First-Line Care:
- Rest & Activity Modification: Pause or reduce running and jumping until pain improves.
- Ice Therapy: 15–20 minutes, 2–3 times daily, especially after activity.
- NSAIDs: Ibuprofen or similar for pain relief (not to play through pain).
- Heel Support: Over-the-counter silicone/gel heel cups in all shoes to cushion and slightly elevate the heel.
- Daily Stretching: Simple calf and Achilles stretching to reduce tension on the growth plate.
Typical Outcome:
Most children improve within 2–7 days with consistent conservative care.
Chronic Sever’s Condition (Persistent Pain > Non-Responding Acute Sever's Treatments)
Key Sign: Heel pain during the Squeeze Test even without recent sports activity → indicates a deeper growth plate bone injury. And of course failure of basic acute severs care.
Why Chronic Cases Need More Care:
The growth plate has become overloaded, injured and stressed. Simple rest/ice, stretching, physical therapy will not resolve the underlying bio-mechanical stress.
Recommended Gold Standard in Treatment
1. Custom Orthotics (Primary Solution)
The biggest differentiator. Chronic cases rarely improve with OTC inserts.
Custom orthotics (like the Mikki Device™) are designed to:
- Remove pressure from the injured heel growth plate
- Redistribute weight across the foot
- Correct underlying issues (flat feet, pronation, high arches)
- Provide superior support and cushioning
Success Rate: 95% improvement, with 50–70% relief in a matter of weeks.
2. Immobilization (When Pain Is Severe)
Used to break the cycle of chronic inflammation, NOT used as primary treatment:
- Walking boot (CAM walker): 2–4 weeks
- Short-leg cast: Rarely, 1–4 weeks
3. Physical Therapy
- PT may focus on stretching and strengthening.
- But: Most chronic Sever’s cases fail PT because this is a bone injury, not a soft-tissue injury.
- Recommendation: PT is not a primary treatment for chronic cases.
4. Footwear Optimization
Chronic Sever’s requires structured shoe support:
Best:
- Supportive athletic shoes (New Balance, ASICS)
- Shoes with stability, cushioning, laces, and firm heel counters
Avoid:
- Barefoot walking
- Minimalist or unsupportive shoes
Chronic sever's - what every parent should know
Key Points:
- Acute vs Chronic – are NOT the same conditions and must be treated differently.
- Chronic – Ongoing heel pain that seems to fail basic treatment protocols.
- Common in “ground and pound” sports like soccer + gymnastics, football, basketball.
- Chronic sever’s often creates a lot of compensatory pain as the child alters their gait. This can be confusing and delay the proper diagnosis.
- Caused by repetitive stress to the calcaneal heel bone, over-loaded growth plate.
- Simple rest, ice, and PT often fail because the injury is to the bone, not soft tissue.
How to Identify Sever’s Condition
The Squeeze Test
3-Step Test:
- Gently squeeze both sides of your child’s heel.
- The child will have pain often withdrawing their foot as you apply pressure.
- Pain at the growth plate = a key sign of Sever’s disease.
“If this test is painful, especially if your child limps or avoids activity, schedule an evaluation.”
How the mikki Device treats chronic sever's Condition
- Custom-molded to your child’s foot shape.
- Custom modification to the heel cup, creating a pocket that removes pressure from the injured heel growth plate. (Without this modification in your child’s orthotic there will likely be minimal to NO response with other orthotic designs.
- Corrects pronation, flat feet, or high arches contributing to pain.
- Works in everyday shoes and cleats.
- Often paired with a nighttime splint for improved recovery.
- 50–70% pain relief in 2 weeks
- 70–100% pain relief by week 4 with consistent use
- 95% success rate in chronic cases
Max's Journey
In This Video You’ll Learn:
- Why Sever’s is the #1 heel pain in active kids ages 6–14
- How the Mikki Device™ off-loads the growth plate
- What the fitting process looks like
- How long recovery takes
- Why Max’s dad recommends seeing a pediatric foot specialist first
Join Us On Facebook for our Sever's Condition Parent Support Group
Success stories
Click Any Card To See The Full Story & Video
Gracies Brave story of her battle with severs disease
Meet Jackson - The Power of a Proper Custom Shoe Orthotic
Meet Ryan - Heel Pain & Severs Disease Treatment Story
Meet Nicholas - No More Sever's Disease!
Frequently Asked Questions
Parents often have similar questions when their child is dealing with heel pain. Here are answers to some of the most common concerns about Sever’s condition.
Sever’s disease is a painful inflammation of the growth plate in the heel bone of children, caused by excessive tension and repetitive stress on the heel.
The main symptoms are pain and tenderness in the heel and arch area. Swelling around the heel may also occur. It is not uncommon for children to have other compensatory pains to their feet, ankles and legs.
It is caused by a triggering event that injures the growth plate, repetitive micro-trauma to the heel growth plate and sometimes related to a heavy heel strike in how a child walks. Sports that involve running and jumping put added stress on the heel.
Sever’s disease typically affects active children between the ages of 6-14 years old. It is more common in boys than girls.
One of the earliest signs parents notice is limping. With heel-related pain like Sever’s disease, children
often change how they walk to avoid pressure on the heel. Common signs include walking on the outside
of the foot or up on the balls of the feet rather than placing the heel down normally.
Traditional treatments for Acute Sever’s include rest, ice, stretching, over the counter anti-inflammatories, and supportive shoe inserts. Chronic Sever’s requires a more aggressive approach with the Mikki Device™ Orthotic, pediatric night brace and prescribed anti-inflammatory.
Limiting activity is sometimes needed to allow heel to rest and recover. However, The Mikki Device™ allows participation in sports to continue while treating Sever’s Disease at the same time.
Yes, Sever’s disease resolves itself once the heel bone stops growing around the age of 13 in girls and 14-15 in boys. However, we do not recommend letting your child suffer with years of pain, especially when orthotic management treatment can resolve this condition in a matter of weeks.
It is possible to have recurrent episodes of Sever’s disease until growth plates close in the early teen years. Using preventative measures can reduce re-occurrence. With proper orthotic management such as the Mikki Device™, it is unlikely to come back.
Yes, untreated Sever’s can lead to a child becoming demotivated to participate in sports and athletic activities. It can also lead to increased pain and discomfort and other compensational pain in the foot, ankle and leg.
In our clinic we see 2-3 children every day with Chronic Sever’s and take great joy in resolving this condition in a matter of weeks. Unfortunately, 5% of children will fail the protocol consisting of a Mikki Device™, pediatric night brace and prescribed anti-inflammatory. These children are often struggling with other undiagnosed pathologies that have to be worked up. In this small group they must be sent out for advanced medical imaging and worked up by a specialist who understands and is an expert with this condition.
Children want to be active and participating in repetitive high impact activities is just part of being a kid! Sever’s growth plate injuries can be very difficult to prevent However, limiting repetitive high-impact activities, using cushioned heel pads, stretching the calf muscles, and having regular foot exams during growth sports can help prevent Sever’s disease.
Depending on your insurance carrier and coverage, orthotic such as the Mikki Device™ and other medical devices are often covered benefits. Our medical office will verify your insurance benefits for you. If your insurance does not cover orthotics we do have cash pay options.
Our clinic is the only pediatric practice that offers the Mikki Device™, a specialty orthotic designed to treat Sever’s Disease at the source. During your visit, Dr. Jarman evaluates your child’s heel pain to ensure an accurate diagnosis. If your child is diagnosed with Chronic Sever’s then we would take a mold of your child’s foot to be sent to the lab for fabrication that day. Most patients receive their device within 7-10 days. With proper wear, the Mikki Device™ removes the pressure from the injured growth plate which in turn, reduces inflammation, supports the heel, and allows your child to return to sports and activity without pain.
In most cases, yes. About 80% of children’s athletic and sports shoes are compatible with orthotics. The
orthotic is designed to fit into common footwear styles without requiring a full wardrobe change.
We recommend shoes that have:
● Laces (for proper support and adjustability)
● A tongue that is not sewn in
● Good shock absorption (similar to a running shoe)
Common brands that typically work well include:
New Balance, ASICS, Brooks (Higher end Adidas and Nikes also acceptable)
Yes. The orthotic can be taken out and placed into whichever shoe your child will be wearing that day, as
long as the shoe meets basic support criteria.
No. As long as your child is improving day by day while wearing the orthotic, there is no need to stop
their regular activities. We may recommend pausing unnecessary or high-impact activities temporarily,
but the goal is to keep kids active while supporting proper healing and progress.
Every child is different, but most families notice gradual improvement as the orthotic begins supporting
the heel and reducing strain on the growth plate. Consistent wear, proper footwear, and activity guidance
all play a role in how quickly symptoms improve.
Your child will be casted in the office, where we take a mold of their foot. The mold is then sent to the
lab, and it typically takes about one to one and a half weeks to be completed and returned.
