Sever’s Disease

How to Identify & Treat Sever's Disease

Sever’s Disease - The Most Common Cause of Heel Pain in Children

What is Sever's Disease?

Sever’s disease, also known as calcaneal apophysitis, is a painful inflamation in the heel that results from a dramatic growth spurt. The inflammation comes about due to an abrupt growth when the heel bone grows at a faster rate than surrounding muscles and tendons which become overstretched and tight.

Girls may see their spurts between 7 – 13  years old while boys will experience them around 10 – 15  years of age (depending on individual children’s development rates).

Sever's disease diagram

How to Identify Sever's Disease

Heel pain on either one or both of the child's heels is the most obvious sign of Sever's.

(*For an official diagnosis, we recommend being evaluated by a pediatric podiatrist or other children’s foot specialists.)

The Diagnosis

"This diagnosis of Sever's is identified easily at the office by simply grasping your child's heel and squeezing firmly on the sides. This will place pressure on the growth plate and in turn immediately result in discomfort for the child."

Dr. Mikkel Jarman

(An MRI and/or xrays are also part of our evaluation to confirm 100% the condition is Sever’s.)

Sever's Disease - What Every Parent Should Know

In the following videos, Dr. Jarman discusses the diagnosis and treatment of Sever’s disease in children, and how to differentiate between acute and chronic.

Video #1 - The Diagnosis

How to diagnose Sever’s and determine if that is the cause or your child’s heel pain.

Video #2 - The Treatment

How to treat Sever’s Disease, and how to tell the difference between acute and chronic conditions.

The Difference Between Acute & Chronic (and why it matters)

Depending on which type of Sever’s your child has, chronic or acute, will determine which treatment options will have the best results.

Acute Sever's

Acute Sever’s is the milder of the two, and will either resolve on its own, or respond very well to conservative treatments like:

  • Elevating the leg and applying ice (not directly on the skin) for 15 to 20 minutes 3 times a day.
  • Over-the-counter medications like Acetaminophen (Tylenol) or Ibuprofen (Advil and Motrin), not aspirin.
  • Rest and ceasing “ground and pound” activities like running, soccer, and gymnastics for two to four weeks.

Almost every young athlete will experience some heel pain from acute Sever’s, but you generally do not need to seek medical care for acute cases. If the child’s heel pain doesn’t resolve on its own and is constant, it is most likely chronic.

Chronic Sever's

Chronic Sever’s is more serious, and as the name implies, is an ongoing condition that affects the child every day even when they are not active. Chronic doesn’t respond to conservative treatments, and a custom orthotic fabricated from the child’s foot specifically is considered the best treatment option.

A custom orthotic:

  • Is cast specifically from your child’s foot for a precise fit and maximum effectiveness.
  • Is a heel cup that evenly distributes the weight taking the pressure off the heel plate allowing it to heal.
  • Is generally prescribed with a nighttime splint to keep the tendons and muscles from tightening back up in the night.

Sever's Disease Testimonials & Success Stories

Sever’s is treatable, both acute and chronic conditions. Watch real life stories of Sever’s disease treatment experiences shared by the children and their parents. 

Meet Gracie

Meet Jackson

Meet Ryan

Meet Nicholas

Causes of Sever’s Disease

The following conditions may increase your child’s chances of contracting Sever’s disease.

  • A pronated foot, or a foot that rolls at the ankle when walking. This may cause a twisting and tightness of the Achilles tendon, which increases the pull on the heel’s growth plate.
  • High or flat arches, which can affect the heel’s angle within the foot.
  • Being overweight or suffering from obesity, which may put additional pressure on the growth plate.
  • Short leg syndrome. This is when one leg is shorter than the other one. Thus forcing the shorter leg to bend down in order to reach the ground.

Adult heel pain  and Children’s heel pain are not the same and are treated differently.

Symptoms of Sever's Disease

Tenderness or pain in either one or both heels is the most obvious sign of Sever’s disease. This usually occurs in the back. However, it is possible for the pain to also go down the sides and the bottom of the heel, right around the arch of the foot.

Other symptoms and problems of Sever's Disease may include:

  • Difficulty with walking
  • Discomfort if the heel is squeezed on both sides
  • Redness or swelling of the heel
  • When walking, the feet are stiff or discomforted
  • Walking unusually, to avoid putting pressure on the heel by walking on one’s tiptoes or with a limp.

Treating Sever's Disease

The first step to a successful outocome is to determine whether or not the child’s Sever’s is acute or chronic. Once that determination is made, the doctor will either recommend conservative treatment options like elevating the foot and rest, if it’s acute, or prescribing a custom shoe insert orthotic if its chronic. 

The primary concern of treating this disease is to relieve the pain.The doctor will usually direct the child to cut back on all activities and sports for either diagnosis until the swelling goes down and the pain is gone. Running barefoot or upon hard surfaces are usually the worst offenders, since they impact the feet and can worsen inflammation and pain. If a child wants to remain active, he or she could try biking or swimming since these do not put pressure on the heel. However, you should go over it with the doctor first.

Children's Feet Treatment Dr. Mikkel Jarman

Doctor may recommend the following for Children with Acute Sever’s disease:

  • Do leg and foot exercises that focus on strengthening and stretching leg tendons and muscles.
  • Use a compression stocking – to decrease swelling and pain.
  • Elevate the leg and apply ice (not directly to the skin). Do this for twenty minutes up to three times a day. It should be done even on days when the pain is not bad. This will help reduce the swelling.
  • Ingest over-the-counter medications that focus on reducing swelling and pain. These include acetaminophen like Tylenol or ibuprofen like Advil and Motrin, not aspirin.
  • Overweight or Obese Children – the odds are good that the doctor will recommend a weight loss regimen in order to decrease the pressure on the heel.
  • If your child has a chronic or severe case of Sever’s disease, the doctor will recommend custom orthotic shoe inserts.

Proper Shoes for Pediatric Heel Pain

It is important that the child wear proper shoes. Find a pair that are good quality, shock absorbent, and are well fitted to help reduce the pressure. In more extreme cases, it may be a good idea to get open back shoes, as they do not rub on the heel. Avoid high heels and heavy shoes. After any and all activities, stretching exercises should be done and the affected heel should be iced.

Shoe Inserts and Orthotic Devices

A child with a pronated foot, high or flat arches, or other such conditions might receive a recommendation from the podiatrist for orthotic devices:

  • Heel lifts that raise the heel and reduce the strain on the Achilles tendon.
  • Arch supports made to keep the heel in a good position.
  • Heel pads that protect and cushion the heel every time it strikes the ground.
Shoes that do not fit well are another contributing factor to the condition. They do not provide enough padding or support, and may rub against the heel. If a child is involved with activities that include running and jumping on hard surfaces, then they may be at risk as well. Common activities include basketball, gymnastics, soccer, and track.

Pediatric Heel Pain

If a child is suffering from pediatric heel pain that affects both the bottom and back of the heel, then they may have a condition called (Sever’s Disease). This pain flares up every time the child does any activity on his or her feet. This means that they are affected whenever they are playing, walking, or even standing. A podiatrist may suggest foot exercises, bed rest, or orthotic devices to help relieve the pain. It is possible for Sever’s disease to heal quickly, but it can recur over the long term if there are no measures taken to protect the child’s heels, especially between the ages 8 to 15, the growing years.

Dr. Mikkel Jarman pediatric podiatrist

All content on PediatricFootAnkle.com is written by or collaborated with Dr. Mikkel Jarman and meets our strict editorial guidelines which include fact checking and peer review. Learn more about our website content and resources policies here: Our Website Content & Resources Policy

Your child’s feet are designed for life

If your child is experiencing heel pain or Sever's disease, make an appointment today.
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