Sever’s disease

What is Sever's disease?

Sever’s disease, also known as calcaneal apophysitis, is a musculoskeletal condition that affects children and adolescents during growth spurts. It involves painful inflammation of the heel bone’s growth plate, usually due to overuse.

Despite the name, it’s not a disease but a temporary condition often seen in active children aged 8 to 13 (girls) and 10 to 15 (boys). It tends to resolve once growth at the heel is complete.

Symptoms

• sharp pain at the back of one or both heels
• swelling, redness, or tenderness in the heel
• limping or walking on tip-toes
• stiffness in the morning
• pain that worsens with activity, especially running or jumping
• pain when the heel is squeezed on both sides

Inflammation can occur when the soft tissues connected to the heel mature more quickly than the bone itself, putting pressure on the bone. Pain is often experienced during adolescent and pre-pubescent growth spurts.

Risk factors

It is more common in active, athletic children and teenagers that play a lot of sport in school and outside school. Some sports are worse than others for exacerbating symptoms, for example, gymnastics in bare feet is typically bad.

Running on tarmac or concrete at length will also likely worsen the condition, as the heel bone is sensitive to repeated pounding into the pavement.

In many cases of Sever’s, the biomechanics of the foot type may increase the chances of developing the disease. These are common foot types that are more likely to develop Sever’s:

• a pronated foot type will cause tightness of the Achilles tendon, which increases the stress over the heel bone
• a high arched foot can also cause tightness over the Achilles tendon
• leg length discrepancy will cause uneven stress on the heel of the shorter leg

Anecdotally, we also see a lot of hypermobile children suffering from Sever’s disease.

Treatment

Orthotic treatment for Sever’s disease often complements rest, ice, and pain relief by helping manage symptoms in active children.

Since the condition is self-limiting and resolves with growth, orthotics are especially useful for those who want to stay active during recovery. Custom insoles can correct foot posture, reduce strain on the heel, and ease tension from the Achilles tendon.

Read about our treatment for Sever’s disease