Sever's Disease

Overview

what it is and why it matters

Sever's disease is the most common cause of heel pain in kids aged 8 to 15, and despite the name, it isn't really a disease. It's irritation at the growth plate at the back of the heel bone, where the Achilles tendon attaches. During the growth spurts of those years, the tendon and calf muscle can pull harder than the still-developing growth plate can comfortably handle. The good news: once the growth plate closes (skeletal maturity), it's gone for good.

It hits active kids hardest, especially soccer, basketball, gymnastics, and running. Pain shows up at the back of the heel, worse with sport and better with rest. On exam, gently squeezing the sides of the heel reproduces the pain.

Symptoms

what you may notice

Pain at the back of the heel, usually both heels, though one side can be worse than the other
Pain that flares during and after running, jumping, or other high-impact sport
Limping or walking on tiptoe to keep pressure off the heel
Stiffness in the heel first thing in the morning or after sitting for a while
Tenderness when you squeeze the sides of the heel (not the bottom)
No swelling, bruising, or redness; Sever's looks normal on the outside

Diagnosis

exam first, imaging second

We diagnose Sever's from the story (heel pain in a growing child that flares with sport) and a focused exam of the heel, gently squeezing the sides where the growth plate sits. X-rays usually aren't needed. When we do order them, it's mainly to rule out other causes of heel pain (a stress fracture, a foreign body, an infection) rather than to confirm Sever's itself.

How We Treat It

what we try first, in order

The reassuring part: Sever's gets better on its own once the growth plate closes, so the whole goal of treatment is to calm the irritation and keep your child comfortable and active in the meantime. The steps below are listed in the order we usually introduce them, each one added on top of the ones before, not instead of.

Activity Modification

Temporarily cut back on running, jumping, and other high-impact sports. Pain settling down is the signal that the growth plate is recovering.

Heel Cup or Cushion

A gel heel cup placed in every shoe absorbs impact and takes some of the pull off the growth plate during walking and sport.

Calf and Achilles Stretching

Stretching the calf muscles and Achilles tendon reduces how hard they pull on the growth plate, which lets the irritation calm down.

Anti-Inflammatory Pills and Ice
An over-the-counter anti-inflammatory like ibuprofen and ice on the heel after activity help with the immediate pain.
Physical Therapy
Once the acute pain settles, structured PT rebuilds calf flexibility and strength so the same pattern doesn't flare back as activity ramps up.

Frequently Asked

questions we hear in clinic

Is Sever's disease actually a disease?

No, despite the name it isn't really a disease. It's irritation at the growth plate at the back of the heel bone, where the Achilles tendon attaches. During the growth spurts of these years, the tendon and calf muscle can pull harder than the still-developing growth plate can comfortably handle.

Will my child grow out of it?

Yes. Once the growth plate closes (skeletal maturity), Sever's is gone for good. Treatment is about keeping your child comfortable and active until then.

Does my child need an X-ray?

Usually not. We diagnose Sever's from the story (heel pain in a growing child that flares with sport) plus gently squeezing the sides of the heel. When we do order X-rays, it's mainly to rule out other causes of heel pain such as a stress fracture, a foreign body, or an infection, rather than to confirm Sever's itself.

Can my child keep playing sports?

Often, but it helps to cut back on running, jumping, and other high-impact sports for a while. Pain settling down is the signal that the growth plate is recovering. A gel heel cup in every shoe and calf and Achilles stretching let your child stay active while the irritation calms down.

Why does it usually affect both heels?

Pain is usually felt in both heels, though one side can be worse than the other. Sever's looks normal on the outside, with no swelling, bruising, or redness, and the tenderness is on the sides of the heel rather than the bottom.