Sever's Disease in Children

Sever's disease — also called calcaneal apophysitis — is the most common cause of heel pain in active children ages 7 to 14. It happens when the growth plate at the back of the heel becomes irritated from sports, running, rapid growth, or injury. It's a specific bone injury, not just soreness, and it's something we diagnose every day.

No. General "growing pains" usually show up as a dull ache in both legs at night. Sever's disease is a specific injury to the heel's growth plate that causes sharp pain triggered by physical activity and direct pressure, and it causes children to guard how they walk, run, and play. Telling the two apart matters because it determines whether your child needs treatment to recover properly.

Common contributing factors include:

• Direct injury to the heel growth plate
• Rapid growth spurts (ages 7–14)
• High-impact sports (soccer, football, basketball, running, gymnastics, dance)
• Flat feet, high arches, or pronated feet
• A tight Achilles tendon
• Extra weight increasing heel pressure
• Leg length differences
• Hard playing surfaces and unsupportive shoes or cleats

Common symptoms include pain localized to the back and sides of the heel that worsens with activity (especially running or jumping) and improves with rest. Children may walk on the outside of their feet, rock onto the balls of their feet, limp, or walk on tiptoes to avoid a heel strike. Tenderness when the heel is squeezed from the sides is a key sign, and both heels are often affected, though one side may be worse.

It's a simple, 3-step way to help identify Sever's disease: we gently squeeze both sides of your child's heel, and if it's Sever's, your child will typically feel pain and may withdraw their foot. Pain right at the growth plate is a key sign of the condition. If this test is painful — especially if your child limps or avoids activity afterward — it's a good idea to schedule an evaluation.

Sever's disease is diagnosed primarily through history and physical exam, not X-rays — X-rays are typically normal for Sever's. We use them to rule out other, more serious conditions like a fracture, stress fracture, bone cyst, coalition, or altered anatomy. In more severe cases, X-rays can sometimes show signs of bone activity around the growth plate called fissuring.

Both aim to reduce pain and pressure on the heel growth plate, but they're treated very differently, and misdiagnosis is common. Acute Sever's is a sudden flare-up, often linked to a recent jump in activity — pain is typically milder, shows up mainly after activity, and responds well to a few days of rest, ice, and NSAIDs. Chronic Sever's is ongoing pain that's been present for weeks, months, or longer, is often constant rather than intermittent, doesn't fully resolve with simple rest and ice, and points to a deeper growth plate injury that needs specialist-guided treatment.

The goal is to calm inflammation quickly and safely return your child to activity. First-line care typically includes resting or reducing running and jumping, ice for 15–20 minutes two to three times daily, NSAIDs like ibuprofen for pain relief, over-the-counter silicone or gel heel cups, daily calf and Achilles stretching, and sometimes a pediatric night brace. Most children improve within 2 to 7 days of consistent conservative care.

A key sign of chronic Sever's is heel pain on the squeeze test even without recent sports activity, along with failure of basic acute-care measures. In these cases, the growth plate has become overloaded, injured, and stressed — this is a bone injury, not a soft-tissue one, so simple rest, ice, or physical therapy alone typically won't resolve the underlying biomechanical stress.

The Mikki Device™ is a custom-molded pediatric orthotic designed to redistribute pressure away from the injured heel growth plate so it can heal properly. It's custom-molded to your child's foot, includes a specific heel cup modification that creates a pocket removing pressure from the injured area, corrects contributing issues like pronation, flat feet, or high arches, and works in everyday shoes and cleats. It's often paired with a nighttime splint for improved recovery. Without the specific heel cup modification, other orthotic designs are likely to give minimal to no response.

With the Mikki Device™, many children see 50–70% pain relief within 2 weeks and 70%+ relief by week 4 with consistent use, with a 95% overall success rate in resolving chronic cases. Custom orthotics are the primary solution for chronic Sever's, since chronic cases rarely improve with over-the-counter inserts alone.

Yes. Children's heel pain is different from adult heel pain and needs to be treated differently — Sever's disease involves the heel's growth plate, which is unique to growing children, while plantar fasciitis involves the plantar fascia soft tissue. Getting the right diagnosis matters for getting the right treatment.

Evaluations are gentle, child-friendly, and focused on function rather than just appearance. During the visit, the doctor makes an active diagnosis, a brace may be provided, our certified medical assistants can cast your child for a custom orthotic, and our insurance coordinator will discuss billing options. You'll leave with an accurate diagnosis (or a list of possible differentials), a clear understanding of that diagnosis, and a full picture of the available treatment options.