Sever's Disease
Also known as or related to: calcaneal apophysitis, heel pain, back of heel pain, kids heel pain
Written and reviewed by Peter Charles, Sports Podiatrist — Shoes Feet Gear, Bardon.
Is It Really Sever's Disease?
Heel pain in children aged 8 to 14 is all too often diagnosed as Sever's disease — by clinicians, and by parents chatting on the sidelines at sport. These children are told they will "grow out of it." They often present to our clinic after one or two years of continual pain, still waiting to grow out of something that was never Sever's disease in the first place.
Just because a child is in the right age bracket doesn't mean every heel pain is Sever's disease. In our experience, the bulk of children who present to our clinic having previously been diagnosed with Sever's are actually suffering from an Achilles injury or another condition entirely.
How to Recognise True Sever's Disease
Genuine Sever's disease has a very specific presentation. The child must be playing a very high volume of sport — multiple sports or multiple teams. The pain typically appears at half time or towards the end of a game, resolves within a few hours, and by the next training session or game the child can run at full power and pace. That recovery pattern is the key distinguishing feature.
Most other heel injuries behave very differently — pain appears as soon as the child sprints or jumps, and doesn't resolve quickly between sessions.
Conditions Commonly Misdiagnosed as Sever's Disease
Common heel pain conditions in children that are frequently misdiagnosed as Sever's include insertional Achilles tendonitis, plantar fasciitis, stress reactions, Baxter's nerve compression, and adventitial bursitis — among others. Each of these requires a different treatment approach, which is why an accurate diagnosis matters so much.
"Careful clinical testing by a very experienced sports podiatrist can identify the true cause of your child's heel pain and get the right treatments in place to return to sport as quickly as possible. If your child has been told to wait it out, it's worth getting a second opinion."
— Peter Charles, Sports Podiatrist & Owner, Shoes Feet Gear Bardon
About Sever's Disease
Description
The large heel bone (called the calcaneus) has a growth plate at the back of the heel. This growth plate is made of soft cartilage and it gradually narrows and starts to turn into solid bone around 8 to 13 years of age. This growth plate is prone to becoming inflamed and painful at this time. The strong Achilles tendon happens to join onto the back of the heel bone and pulls on this growth plate when running, causing Sever's disease.
Symptoms
Children aged between 9 to 13 years of age can experience Sever's disease, with girls normally younger and boys slightly older. Sever's disease normally involves the back of the heel bone becoming painful towards the end of intense or prolonged activity and can remain painful after the activity for a few hours. Severe cases can result in limping and pain that can even remain the next morning after sport.
Causes
The more active a child is, the greater the chance of suffering from Sever's disease. Poor foot function such as flat feet causes the calf and Achilles to work harder and pull on the growth plate. Tight calves or Achilles tendons are common in growing children and increase tension on the growth plate during running and jumping.
Treatments
All of our treatments for Sever's disease target one of two things: reducing the tension in the calf and Achilles tendon that is pulling on the growth plate, or reducing the load going through the growth plate during activity. Icing heels afterwards and taking pain relief simply numbs the pain — it does nothing to address the cause. Our goal is to reduce the pain from appearing in the first place.
Reducing Calf and Achilles Tension
Tension and pulling from the Achilles tendon irritates the cartilage growth plate, so reducing that tension is the first priority. We do this through:
Calf and soleus release — specific stretching protocols targeting both the gastrocnemius and soleus, combined with foam rolling, massage gun work, and hands-on soft tissue release from our clinicians. The soleus in particular is often overlooked but is a significant contributor to growth plate load in active children.
Heel elevation — lifting the heel instantly reduces the pull angle of the Achilles on the growth plate. We select specific shoe brands and models with higher heel-to-toe drops as an immediate intervention, and add heel lifts inside key shoes — particularly school shoes and training shoes — to maintain that reduction throughout the day.
Reducing Load on the Growth Plate
Prescription orthotics — used selectively for children with poor foot mechanics and excessive pronation. A pronating foot creates a torsional pull of the Achilles on the growth plate, and also forces the calf and Achilles to work much harder to stabilise the heel during each stride. By supporting the foot and keeping the heel aligned, we reduce both the rotational load and the overall workload of the Achilles — significantly reducing the force going through the growth plate. Not every child with Sever's needs orthotics; they are indicated when foot mechanics are a primary driver.
Gait modification — we analyse each child's running gait and look for opportunities to run more efficiently with less calf load. This might mean transitioning from forefoot striking back to heel striking, or incorporating more quad and glute drive so the child is pushing forward rather than relying on the calf to propel them. Significant load redistribution is possible with targeted gait changes, and children adapt quickly.
Training schedule modification — rather than quitting sport or skipping games, we work through each specific training and activity to identify when the highest load is going through the heel, and look to remove the lowest-value running from the weekly schedule. Dead running — fitness drills that aren't enjoyable and aren't sport-specific — is often the easiest to remove without disappointment. Sometimes the simplest solution is wearing shoes in the backyard rather than going barefoot, which immediately reduces compression on the growth plate.
A practical example: a child doing serious cross-country training who also plays netball and rugby union may be doubling up on fitness work unnecessarily. Cross-country provides more than enough cardiovascular load, so skipping the fitness component of netball or rugby training that week removes a significant amount of heel load without the child missing any actual sport. This requires working with coaches, parents, and the child together — all parties want the child playing pain-free and performing at their best.
Frequently Asked Questions
What age does Sever's disease occur?
Sever's disease only occurs during the window when the cartilage-like growth plate at the back of the heel is in the process of fusing into solid bone. Girls tend to develop earlier and can be affected from around 9 to 11 years of age. Boys tend to be slightly later, typically 11 to 13. Outside of this age range — younger than 9 or older than 13 — a diagnosis of Sever's disease should be questioned, and a thorough assessment for other heel conditions is essential.
Does my child have to wait to grow out of Sever's disease?
No — your child does not need to suffer and simply wait. There is a great deal that can be done to reduce the pulling load on the growth plate while still allowing them to continue playing sport. Simple interventions like calf stretching and releasing, heel lifts in shoes, and avoiding flat footwear can make a significant difference. We can also use prescription orthotics to change the alignment and force on the growth plate, modify run technique, and selectively reduce the least enjoyable or lowest-value running in their week. The real danger of waiting is that some children we see actually have serious injuries — heel stress reactions or significant Achilles injuries — and they continue to suffer for years, only seeking treatment at 14 or 15 when they haven't "grown out of it" as expected.
How much sport does my child need to be doing for it to be Sever's disease?
Clinically true Sever's disease typically requires high-intensity, high-volume running on most days of the week. A child playing one game and one training session per week is unlikely to have enough load on the growth plate to produce genuine Sever's disease — and if they do have heel pain, it is highly likely to be an actual structural injury. Children with true Sever's are typically playing club sport, school sport, representative sport, or multiple running-based sports simultaneously. It's also worth considering playground activity — some children play only one organised sport but are running hard before school, at both lunch breaks, and after school. If your child's sport load is relatively light and they have heel pain, a thorough assessment is important.
What should I do if Sever's disease treatments aren't helping?
If the pain isn't reducing or responding to typical Sever's disease treatments, we become very suspicious that there is an actual structural injury to the heel rather than growth plate inflammation. A key clinical indicator: if a child has not done any significant running or jumping for more than 48 hours and is still in pain, they have an injury to the heel structures — not Sever's disease. In this situation, an accurate assessment and diagnosis is essential before continuing any treatment plan.
Can Sever's disease affect both heels?
Yes — bilateral heel pain is common in children with true Sever's disease, particularly those playing very high volumes of sport. However, pain that is significantly worse on one side, or that behaves differently between the two heels, warrants careful assessment. Asymmetric presentations often indicate that one heel has a different or additional injury alongside the growth plate inflammation.
Our Bardon clinic serves families from Paddington, Ashgrove, Toowong, Red Hill and across Brisbane's inner west.