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HomeHealth TopicChildren's Health

What Is Sever’s Disease (Calcaneal Apophysitis)?

Lauren Geoffrion, MDAunna Pourang, MD
Written by Lauren Geoffrion, MD | Reviewed by Aunna Pourang, MD
Published on December 9, 2021

Key takeaways:

  • Sever’s disease (calcaneal apophysitis) is caused by swelling of a part of the heel bone attached to a growth plate (the calcaneal apophysis).

  • Kids get Sever’s disease because their heel bone grows faster than their surrounding muscles and tendons, so if the tendons pull too tightly on the heel, it can irritate the growth plate.

  • With rest, ice, and a proper heel support, Sever’s disease usually resolves on its own. 

Close-up of a doctor examining a patient's ankle and foot. You can only see from the waist down of the person on the exam table. They are wearing light blue jeans.
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Children are filled with energy, and what better way to use this energy than playing sports? 

But growing up and playing sports can come with some growing pains of their own. One issue that may come up in kids who play sports is Sever’s disease, which is the most common cause of heel pain in children. It usually improves with time, rest, and a little bit of TLC — and your little one can get back to playing sports again in no time.

What causes Sever’s disease (calcaneal apophysitis)?

You may have noticed that your child complains about heel pain after starting a new sport or playing one for a long time. If their pain is due to Sever’s disease, it has to do with what’s called the calcaneal apophysis, which is the part of the calcaneus (heel bone) attached to the heel growth plate. 

Before adulthood, certain bones, like the long bones in the arms and legs, have what are called growth plates. They stay open as we grow before fusing with bones when we stop growing. So, they have to be more flexible even though they’re part of the bone. This is good for growing but not very good for holding up under a lot of pressure. 

Your child’s bones are growing faster than the muscles and tendons, and feet are usually one of the first body parts to grow during a growth spurt. So, playing sports that involve repetitive running or jumping can cause the muscle and tendons to pull on the heel growth plate and irritate it. When this happens over and over again, it can cause inflammation of the calcaneal apophysis, leading to calcaneal apophysitis. 

This condition was named after Dr. James Warren Sever, who first described it in 1912. 

Why do kids get Sever’s disease?

Kids get Sever’s disease because they’re growing and they have growth plates, one of them being the heel growth plate. The heel growth plate (as well as all other growth plates) in adults is fused, so they will not experience Sever’s disease. 

Even though it’s possible for kids as young as 7 years old to have Sever’s disease, the most common ages to get it are between 8 and 15 years old. Sever’s disease is more common when a child is having their growth spurt.  

What are the symptoms of Sever’s disease?

Your child may complain about a few different symptoms if they have Sever’s disease, including: 

  • Pain in one or both heels: This is typically worse when running in cleats or other shoes that don't provide good heel support. Also, it usually occurs without any specific injury to the area and tends to improve with rest. 

  • Difficulty walking due to pain: You may notice that your child limps or walks on their toes so that they don’t bear weight on their heel.

  • Swelling around the heel: This symptom, along with pain, may also mean there’s another cause for the pain, like a stress fracture, an ankle sprain, or something else, especially if the area is red.

How is Sever’s disease diagnosed?

Your child’s healthcare provider can usually diagnose Sever’s disease based on their  symptoms and a physical examination

One special test that can help make the diagnosis is called the squeeze test: If it’s painful when  the inside and outside of the heel are squeezed at the same time, then Sever’s disease is very likely. 

Usually, imaging, like X-rays, ultrasound, or MRI aren’t needed to diagnose Sever’s disease. But sometimes imaging can be useful to make sure the pain isn’t from a fracture or something else. Also, X-rays can be helpful if a healthcare provider isn’t 100% sure if it’s Sever’s disease — because if the growth plates are almost completely closed, the provider may evaluate other possible causes of heel pain. 

How does Sever’s disease differ from plantar fasciitis?

Both Sever’s disease and plantar fasciitis can cause heel pain. But their causes differ.

Sever’s disease is caused by inflammation of the growth plate, which is part of the bone. But plantar fasciitis is caused by inflammation of the plantar fascia, which is a ligament that connects your heel to your toes. Because of this, Sever’s disease can only happen in children, while plantar fasciitis can happen at all ages. 

The pain experienced with plantar fasciitis usually occurs with the first steps after waking or after long rest periods. Another difference is that there can be pain along the bottom of the foot and not just the heel. 

Since the symptoms and physical exam findings are unique for both conditions, your child’s healthcare provider will be able to tell the difference. 

How is Sever’s disease treated?

Some of the best things that can help your child deal with Sever’s disease are remedies that  can be done at home. One effective method to treat many sports-related conditions is called the R.I.C.E. Method:

  • Rest: Have your child take a break from sports or whatever causes the pain, and have them try to stay off their feet a little more than usual. 

  • Ice: Put an ice pack on the painful area for 15 to 20 minutes at a time after having pain or after activity, but only 4 to 8 times a day. 

  • Compression: In cases of heel swelling, wrap the area snugly for support but not so tightly as to cut off the blood supply.

  • Elevation: If the child’s heel is swollen from Sever’s disease, wrapping it will usually be enough. But the child can also lie down and prop their leg up on some pillows for a few hours per day to help with swelling, if needed.

Gentle stretching exercises that involve stretching that calf and heel can also help relieve pain. If your child is getting better and back to playing sports again, they may want to wear supportive shoes or inserts. These can reduce some of the tension from the tight tendons and give a little cushion to reduce further damage.

Sometimes, if the pain is worse than usual, pain relievers may help. Acetaminophen (Tylenol), or nonsteroidal anti-inflammatory drugs (NSAIDs) (like ibuprofen or Motrin) at the recommended dose can reduce pain during the healing process. In rare cases, a cast can be used for a short time as a sort of heavy-duty supportive shoe. 

Currently, surgery isn’t a recommended treatment option for Sever’s disease. 

Will Sever’s disease go away on its own?

Yes, eventually, when a child stops growing. In the meantime, your child will have to at least take a break from sports and other triggering activities to experience pain relief. And even with recommended home remedies, the pain can still recur until a child is done growing.   

The good news is that Sever’s disease won’t cause long-term issues, even if your child gets it over and over again. And after the growth plates close, Sever’s disease goes away for good. 

How long is the recovery for Sever’s disease?

It can take anywhere from 2 to 8 weeks for Sever’s disease to completely go away. It depends on how bad the growth plate was irritated before starting treatment. Each person is different, and sometimes it can take longer for some children to heal. 

Is Sever’s disease preventable?

A great solution for many conditions is to try to prevent them in the first place. Here are a few ways to help prevent your child from getting Sever’s disease:

The bottom line 

Childhood is filled with many growing pains. Sever’s disease is one of those painful conditions that preteen athletes may experience. Like many body injuries caused by overuse, rest, ice, and over-the-counter pain meds usually do the trick. Before you know it, your child’s heel growth plate will fuse, and Sever’s disease will be no more. 

References

Achar, S., et al. (2019). Apophysitis and osteochondrosis: Common causes of pain in growing bones. American Family Physician. 

Busscher, I., et al. (2011). The value of shoe size for prediction of the timing of the pubertal growth spurt. Scoliosis.

View All References (7)

Fares, M.Y., et al. (2021). Sever’s disease of the pediatric population: Clinical, pathologic, and therapeutic considerations. Clinical Medicine and Research.

James, A.M., et al. (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.

Micheli, L.J., et al. (1987). Prevention and management of calcaneal apophysitis in children: an overuse syndrome. Journal of Pediatric Orthopedics.

Mirtz, T.A., et al. (2011). The effects of physical activity on the epiphyseal growth plates: A review of the literature on normal physiology and clinical implications. Journal of Clinical Medicine Research. 

OrthoInfo. (2018). Sever’s disease

Smith, J.M., et al. (2021). Sever’s disease. StatPearls Publishing. 

Tu, P., et al. (2011). Diagnosis of heel pain. American Family Physician.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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