Sever’s Disease and Heel Pain in Children

Heel pain is common in children. While it may be the result of a specific injury, it is also commonly caused by something called Sever’s disease, a type of overuse syndrome similar to shin splints or Osgood-Schlatter disease.

Children with Sever’s disease (also known as calcaneal apophysitis) develop microfractures where the Achilles tendon inserts on the calcaneus (the large bone that makes up the heel of the foot). These microfractures can cause pain depending on the type of activity your child is doing. The pain generally gets worse with activity and improves with rest.

Kids running in a park outdoors
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Sever’s disease is more common in boys and typically occurs when the child is between 8 and 15 years old. Although it can affect both heels, it more commonly just affects one. It is a disease of overuse, most often caused by playing sports or any activity which involves a lot of heel motion or impact.

Sever’s disease is commonly seen at the beginning of a school sports season. Children going through adolescent are especially prone to the disease as the heel bone will typically grow faster than the leg. It more often occurs in children whose feet and ankles roll inward when standing (referred to as either “flat feet” or over-pronation).

Symptoms and Diagnosis

Heel pain is the defining symptom of Sever’s disease, located either to the back (posterior) or toward the front adjacent to the arch (plantar). Unlike a heel or ankle injury, there will be little to no swelling or redness. The pain, however, can sometimes be so severe as to cause limping or a tiptoed gait.

Diagnosis involves a simple test in which the doctor squeezes the sides of the heel to determine where the pain is.

Plantar fasciitis is another common cause of heel pain, but unlike Sever’s disease, the pain is mostly felt when the activity is first started. After 10 to 15 minutes of activity, the pain will “work itself out” and resolve its own. This is the main differentiator between the two conditions.


Treatment of Sever’s disease involves physical therapy as well as rest, application of ice, and stretching exercises.

Heel pads, lifts, or cups are also recommended to protect the heel and minimize the impact of walking or bumps.

For severe pain, a short leg cast or a walking boot may be helpful. If the pain isn’t too bad, a heel pad and exercise may suffice. However, if the symptoms don’t improve, immobilization may be needed.

3 Sources
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  1. Fares MY, Salhab HA, Khachfe HH, Fares J, Haidar R, Musharrafieh U. Sever’s disease of the pediatric population: clinical, pathologic, and therapeutic considerations. Clin Med Res. 2021;19(3):132-137. doi:10.3121/cmr.2021.1639

  2. Gao Y, Liu J, Li Y, Liu Q, Xu S. Radiographic study of Sever’s disease. Exp Ther Med. 2020;20(2):933-937. doi:10.3892/etm.2020.8796

  3. Belikan P, Färber LC, Abel F, Nowak TE, Drees P, Mattyasovszky SG. Incidence of calcaneal apophysitis (Sever’s disease) and return-to-play in adolescent athletes of a German youth soccer academy: a retrospective study of 10 years. J Orthop Surg Res. 2022;17(1):83. doi:10.1186/s13018-022-02979-9

By Vincent Iannelli, MD
 Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.