Sever's Disease

What is Sever’s Disease?

Sever’s disease or calcaneal apophysitis (growth plate) is a very common cause of heel pain in children and adolescent athletes. It is most common between the ages of 8-14 years of age, especially during a period of rapid growth, combined with a high level of sporting activity.
Sever’s disease is more likely in teens who participate in sports that involve running, twisting and jumping, such as basketball, football and gymnastics.

Sever’s disease is thought to occur in children due to the mismatch in growth between the faster growing bones and slower growing muscles and connective fascial tissue of the body.

When the bones lengthen and the muscles don’t, the calf and its tendon (Achilles tendon) become tight, putting extra-stress on its attachment site on the heel bone (Calcaneus), and causing a traction injury.

The traction causes tiny bits of bone to pull away, causing inflammation, which is when the pain usually begins.


  • Pain at the back or bottom of the heel
  • Limping
  • Walking on toes
  • Pain when contracting the calf  against resistance
  • Pain when sides of the heels are squeezed together
  • Tenderness and pain becoming worse during and after exercise


Treatment options

It is vital to see a physiotherapist immediately the heel symptoms occur as it can be a long protracted condition keeping the child/ teenager away from the sport they love dearly. A headache for the parents to have a non-active child/teenager at home playing excess amount of electronics and developing other issues from this.

Any activity can cause Sever’s Disease, but it’s more common in activities that involve a lot of jumping and cutting, like basketball, netball, volleyball, soccer and gymnastics.

The good news is that you can help treat the pain in your ankle by using the RICE protocol.

  • Rest the heel from the painful activity
  • Ice the affected area for 20 minutes, 3 times a day
  • Compress the painful area with an elastic bandage
  • Elevate the leg

It is vital you get immediate treatment by physiotherapy to assess, treat and manage the underlying issues that are contributing to overloading the painful heel during activity/sport. 

A consultation with a physiotherapist involves looking at how your ankle is moving (biomechanics), for example, running style, length of calf muscles especially the power calf muscle, gastrocnemius or how you play sport.

 A full investigation of the length of all myofascial bands in the body. Tightness in these areas may contribute to the problem during your growth spurt. We need to assess the growth and control of the whole body not just focus on the ankle.

Following this assessment the physio will commence treatment. This could involve a range of techniques such as massage, joint mobilisation, taping, stretches, strengthening exercises, soft cushioning heel raises placed in the back of your shoes to name a few.

A trend in our clinic is teenage athletes are commencing clinical Pilates classes with other teenagers. The common emerging thread is too much time on the electronics in their down time resulting in a deconditioned abdominal cylinder ‘core’. The power leg muscles then work overtime on the sporting field as the core is not as toned as responsive as would be ideal for such a high level of physical activity.

The body is unbalanced as kids are not running around climbing trees and walking long distances as they did in the past. Our observation is these growth plate conditions in children are on the rise.

Small changes following can help reduce the pain you are experiencing, so you can get back onto the sporting field with your mates.

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