Children's Hospital Colorado: Growth Related Injuries, Sever's Disease (chronic heel pain)

Children's Hospital Colorado: Growth Related Injuries, Sever's Disease (chronic heel pain)

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What is Sever’s?

Sever’s Disease, also known as calcaneal apophysitis, is a condition that affects active, growing children. It occurs during a specific period of development when the heel bone (calcaneus) is still growing. This painful condition occurs around and underneath the heel, where the bone is made of softer cartilage and is susceptible to overuse. Active children place excessive pressure on this growth center where the Achilles tendon attaches to the heel bone. Eventually, the excessive stress and tension can cause pain, swelling and soreness.

What are the causes and who is at an increased risk?

Bones tend to grow faster than muscles and tendons. This can cause decreased flexibility and lead to irritation at the muscle’s insertion sites onto the bones.

Children who are involved in numerous running and jumping activities are at a higher risk for developing this condition. In girls, the condition typically develops around the ages of 8 to 10 years old. In boys, it develops around ages 10 to 12.

Signs and symptoms

Symptoms may vary for each individual, some of these include:

  • Increased heel pain with activity.
  • Heel pain that usually fades with rest.
  • Tenderness around the heel when touched or squeezed.
  • Limping or walking on toes to avoid pressure on the heel.


This condition can be frustrating, and pain will fluctuate during the entire time of this growth stage (usually around 2 years). Once the growth plate has finished developing, the pain usually fades. Some tips that may help your child manage their pain include:

  • Participate in activities only as tolerated; do not over extend or push through the pain
  • Ice and/or ice massage (20 minutes at a time, 2-3 times a day)
  • Wear gel heel cup inserts
  • Take anti-inflammatory medication (Aleve, Motrin, etc.)
  • Vary activity with low impact aerobic training such as walking, riding a bike, elliptical or swimming.
  • Develop a home exercise program focused on increasing flexibility and strengthening the calf, Achilles tendon and hamstrings (SEE BELOW)

When should you rest from activities?

Rest immediately when pain has significantly increased, causing your child to limp or change his/hers biomechanics. This can lead to further, possibly more damaging injuries. Take the time to allow the inflammation to decrease, and then once pain and symptoms have subsided, gradually increase return to sports.

Steps to follow to help decrease symptoms:

  1. Warm up- this should be a dynamic, sport-specific warm up
  2. Follow the home exercise program below
  3. Cool downs- stretch and ice after games/practices to help with any increased symptoms and to help prevent pain from increasing
  4. Proper footwear- if you wear heel cups in your athletic shoes, also make sure to have a pair in your everyday shoes


Recovery time will vary from child to child. Age, health, activity level, previous injuries and severity of symptoms will affect recovery time. Doing the exercise program may help decrease your healing time. Complications related to this condition are rare and the pain will usually fade after the bone has finished growing.

For more information on Sever’s disease or if you have any questions or concerns please feel free to contact Virginia Winn, MSc, ATC at