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Heel Pain in 8 to 15 year olds: What is Sever's Disease?

What is Sever's Disease?

Sever's Disease is characterised by heel pain with activity in growing 10-12 year olds. Active children who are going through a growth spurt can be subject to a variety of tendon-related conditions. Similar to Osgood-Schlatter's Disease of the tibial tuberosity (knee), Sever's Disease is another type of traction apophysitis, but affecting the calcaneus (heel).

Who is affected?

Sever's Disease affects 8-15 year olds who are going through a growth spurt. It is more common in boys than in girls in an incidence of 3:1. It can occur in either 1 or both heels, and it is due to several factors including:

What are the causes?

  1. Growth spurts

  2. Activities involving running and jumping, such as soccer

  3. Overuse, or sudden changes in sport load/demand

  4. Obesity

  5. Biomechanical factors involving the foot and ankle

  6. Dysfunctional (weak, tight) gastrocnemius and soleus muscles (calf muscles)

  7. Worn out or poorly cushioned footwear

How is it treated?

Sever's is typically managed conservatively. Education for the parents and coaches is essential. Rest is helpful in this condition, and it will often resolve in weeks to months with rest; it inevitably resolves with time when the growth plate fuses in the calcaneus (heel).

Other treatment options include a heel cup, and a randomised controlled trial by Perhamre et al found an 80% pain reduction in children using a heel cup while remaining active in their sport of choice. This may be an evidence based treatment option for those who wish to continue with their activity levels. Orthotics can also be trialed.

Stretching, massage, taping, and strengthening a variety of muscle groups are other conservative measures to treat Sever's disease. If the condition has not resolved after the growth spurt, or if the


James AM, Williams CM, Haines TP. "Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever's disease): a systematic review". J Foot Ankle Res. 2013 May 3;6(1):16. doi: 10.1186/1757-1146-6-16. PMID: 23641779; PMCID: PMC3663667.

Perhamre, S., Lundin, F., Norlin, R. and Klässbo, M. (2011), Sever's injury; treat it with a heel cup: a randomized, crossover study with two insole alternatives. Scandinavian Journal of Medicine & Science in Sports, 21: e42-e47.

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