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What is Sever's Disease in Children?

What is Sever’s Disease in Children?

Sever’s disease, or calcaneal apophysitis, is the primary cause of heel pain in children. Primary risk factors in pediatric athletes are obesity and high levels of physical activity.

Sever’s injury primarily results from high-impact sports such as soccer, track, cross-country, gymnastics, tennis, and ballet. This injury mainly occurs during puberty with an open growth plate in the immature calcaneus.

It can occur in one foot or both feet heel pain located to the posterior calcaneus, usually at heel strike. Maximal pain after exercise or impact sports may result in a limp and inability to play sports.

What Causes it?

Sever’s Disease occurs at the posterior secondary ossification centre of the calcaneus.

It can also occur during ossification (7-14 years), in active children who participate in sports involving repetitive contraction of the calf muscles will cause traction forces from the Achilles on the posterior calcaneus causing micro-fractures.

Some risk factors of this condition can be growth spurts on the foot, obesity and risk of weight gain and structural foot deformities.

What to look for

Oedema is an indicator of Sever’s. It is fluid retention which can be most easily seen around the ankles after you’ve been standing (peripheral oedema).  In severe cases, oedema can also collect in your lungs and make you short of breath.

Warmth and heat around the area may also be present, as can redness or a stiff blunt feeling.

Palpation of the apophyseal margin of the calcaneus by squeezing the medial and lateral heel will elicit pain.

Passive Dorsiflexion of the foot can elicit pain, as can active tiptoeing.


There are a few ways to manage the pain and general area, these include:

  • Stretching calves to maintain flexibility
  • Modifying shoes with a heel raise to reduce the pull of Achilles on the heel.
  • Modification of sport.
  • Address any underlying biomechanical issues which may contribute to Achilles strain and prescribe a custom made orthotic. Custom made orthotics for children with foot deformity assist in improving gait cycle and reduce pain. Children enjoy movement and playing sports so it is important to check our children’s feet to avoid complications and muscle pain.
  • Speaking to an accredited professional who can assess the area and recommend further treatment.

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