A common reason for growing children and adolescents to experience pain in the back of their heel during or after sport is due to Sever’s Disease. Sever’s Disease is an overuse injury to the growth plate in a child’s heel. 1



How to tell if your child is affected by Sever’s Disease?

  • Pain in the back of the heel on one or both legs
  • Pain with running or jumping
  • May limp at end of sport or the following day
  • Pain gradually resolves with rest

These symptoms combined with an increase or a large amount of sports participation, particularly in sports like gymnastics, basketball or soccer are a strong indication your child may be experiencing Sever’s. They may have also had a recent growth spurt.

How does the growth plate become injured?

Bones in the lower leg tend to grow a lot faster than the calf muscles in the lower leg and the Achilles tendon that these muscles are attached to. As a result, the muscles pull on the Achilles tendon, which in turn pulls on the growth plate in the heel.1 Because this growth plate hasn’t finished developing, the constant pull from excessive use of the calf muscles results in irritation of the growth plate and subsequent pain.1 Therefore, if your child is engaging in a lot of sporting activity that involves large amounts of running and jumping, and experiencing a growth spurt, they are at greater risk of experiencing heel pain due to Sever’s.

Sever’s is a very common condition among children and has an excellent prognosis, with complete resolution of symptoms once the growth plate fuses so there is no cause for alarm.2

Why should I see a Physio for my child’s heel pain?

Diagnosis of Sever’s can be made by a Physiotherapist by listening to the family and child’s experience of pain, and completing a series of tests to confirm. X-ray plays an insignificant role in diagnosis.

Following diagnosis, the Physiotherapist will be able to collaborate with you and your child to form a treatment plan that best manages the child’s pain, and meets the child’s goal for participation in sport. Treatment will be based on the individual, but typically consists of:

  • Relative rest from activity as guided by pain2
  • Icing after exercise1
  • Stretching and strengthening of the calves2
  • Prescription of either a heel lift or orthotics as indicated3
  • Taping of the ankle and foot before sport

Reference List:

  1. Smith, J. M., & Varacello, M. (2019). Sever’s disease. Available from https://www.ncbi.nlm.nih.gov/books/NBK441928/
  2. Ramponi, D. R., & Baker, C. (2019). Sever’s disease (Calcaneal apophysitis). Advanced Emergency Nursing Journal, 41(1), 10-14. doi:10.1097/TME.0000000000000219
  3. James, A. M., Williams, C. M., & Haines, T. P. (2013). Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever’s disease): a systematic review. Journal of Foot and Ankle Research, 6(16), 1-11. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663667/pdf/1757-1146-6-16.pdf