Sever's Disease - Calcaneal Apophysitis

What is Sever’s Disease:

Sever disease is painful irritation and inflammation of the apophysis (growth plate) at the back of the calcaneus (heel bone), where the Achilles tendon inserts. Also can occur due to the muscle and tendons of the growing foot do not keep pace with the bone growth. In a child, the bones grow from areas call growth plates. The growth plate is made up of cartilage, which is softer and more vulnerable to injury than mature bone.

Most Common Causes:

Sever’s Disease is most often seen in physically active boys and girls between the ages of 8 and 13 years and is the most common cause of heel pain in this age group. It is most commonly seen in soccer, basketball and gymnastics. Approximately 60% of Sever’s disease is bilateral. The pain is caused by repetitive tension and/or pressure on the growth center. Tight calf muscles are a risk factor for Sever because they increase the tension on the growth center. Sever can also result from wearing shoes with poor heel padding or poor arch support.

Most Common Symptoms:

Your child will complain of acute pain in the heel. The pain usually occurs during or after activity (typically running or jumping) and is usually relieved by rest. The pain may be worse with wearing cleats. This pain may limit your child’s activities and when severe, may cause a limp. Children who are active athletes are among the group most susceptible to experiencing Sever's disease. This is due to the extreme stress and tension placed on their growing feet.

How is it diagnosed?

Sever disease is diagnosed based on your doctor’s physical examination of the lower leg, ankle and foot and review of your child’s symptoms. If the diagnosis is in question, your doctor may order x-rays to evaluate for other injuries that may be causing the heel pain. In Sever disease X-rays are typically normal.


How is it treated?

  • Short period of rest from painful activities
  • Anti-inflammatory therapy: Ice, NSAIDs
  • Shoe gear modification
  • Stretching
  • Heel cups
  • Orthotics

Why is treating the heel pain important:

The constant pain experienced at the back of the heel may cause the child the inability to put any weight on the heel. This forces the child to bear weight on their toes while walking. When a toe gait develops, the child must change the way they walk to avoid placing weight on the painful heel. If this is not properly addressed, this can lead to further developmental problems.

Can Calcaneal Apophysitis Be Prevented?
The chances of a child developing heel pain can be reduced by:

  • Avoiding obesity
  • Choosing well-constructed, supportive shoes that are appropriate for the child’s activity
  • Avoiding or limiting wearing of cleated athletic shoes
  • Avoiding activity beyond a child’s ability.

Here at Kalmar Family Podiatry, we pride ourselves on our ability to diagnose and treating young athletes and active children. If your child is having signs and or symptoms of sever’s disease please call us at 631-549-0955 or contact us below to schedule your appointment today. 


Please do not submit any Protected Health Information (PHI).

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