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!
Sever’s condition is the #1 cause of heel pain in active kids. Learn the signs, how to accurately diagnose it. Understand what works and doesn’t work, what you can do at home. When chronic pain needs specialist care.
Trusted Pediatric Foot & Ankle Care • Thousands of children treated by Dr. Mikkel Jarman, DPM, FACFAS
What is sever's Disease?
Sever’s condition is a bone injury NOT a soft tissue injury. This injury occurs at a child’s heel’s growth plate and causes it to become inflamed and swollen. The Achilles tendon attaches to this growth plate, pulling on it during activities, and will intensify a child’s symptoms.
Key Causes:
- A triggering event that injured the growth plate
- Repetitive stress from sports activities
- The way a child walk, a heavy heal strike
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 differs significantly from adult presentations and requires a distinct 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 SEVER'S condition
- 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.
Acute vs. Chronic Sever’s — Why It Matters?
Sever’s disease may present acutely or chronically & identifying the correct form is key to effective treatment. Misdiagnosis is common.
| 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 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™.
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:
- Chronic = ongoing heel pain during growth spurts.
- Common in “ground and pound” sports like soccer + gymnastics.
- Caused by repetitive stress and an inflamed, 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.
- Ask if it hurts when you apply pressure.
- Pain at the growth plate = a key sign of Sever’s disease.
Demonstration of the heel squeeze test
“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
The Mikki Device™ is a custom-molded pediatric orthotic designed to redistribute pressure away from the injured growth plate so it can heal properly.
- Custom-molded to your child’s foot shape.
- Removes pressure from the heel growth plate.
- 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 8–14
- 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
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Success stories
Click Any Card To See The Full Story & Video
She went from crawling and sitting in a wheelchair to standing next to my bed that morning on her feet, and it was amazing!
Gracies Brave story of her battle with severs disease
Today versus a few months ago is a huge difference. From sitting inside while other friends were out playing while he was in a lot of pain. To now being excited he could join & play baseball outside.
Meet Ryan - Heel Pain & Severs Disease Treatment Story
“He’s back to his old Jackson. He’s back to running, and he doesn’t complain of foot pain at night, and he wakes up, and he’s ready to start his day!”
Meet Jackson - The Power of a Proper Custom Shoe Orthotic
I called that day & they were able to get us an appointment that very same day without hesitation which was fantastic! Dr. Jarman was excellent in explaining everything.
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 caused by repetitive micro-tears to the Achilles tendon where it attaches to the growth plate in the heel. Sports that involve running and jumping put added stress on the heel.
Sever’s disease typically affects active children between the ages of 8-15 years old. It is more common in boys than girls.
Traditional treatments include rest, ice, stretching, over-the-counter anti-inflammatories, and supportive shoe inserts. Mikki Device™ offers an additional treatment option.
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, our doctor evaluates your child’s heel pain, takes measurements, and fits the device specifically to your child’s feet. Most patients receive their device the same day, so treatment can start immediately. With proper wear, the Mikki Device™ helps reduce inflammation, support the heel, and allow your child to return to sports and activity without pain
Limiting repetitive high-impact activities, using cushioned heel pads, stretching the calf muscles, and having regular foot exams during growth spurts can help prevent Sever’s disease.
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. This may take 1-2 years in most kids.
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.
No, Sever’s disease does not lead to any long-term complications once the condition resolves as the child’s heel finishes growing.