Your Child Has Heel Pain: Could It Be Sever’s Disease?

Your Child Has Heel Pain: Could It Be Sever’s Disease?

If your growing child develops heel pain during soccer, basketball, gymnastics, running, or another active sport, you may hear the diagnosis Sever’s disease.

Despite its alarming name, Sever’s disease is not an infection or a permanent disease. Its medical name is calcaneal apophysitis, which means irritation of the growth area at the back of the heel.

It is a common cause of heel pain in active, growing children—especially during a growth spurt. The good news is that it does not typically cause permanent damage. With appropriate management, most children can remain active at a level their symptoms tolerate and gradually return to full participation.

Why does Sever’s disease happen?

A child’s heel contains a growth area where the Achilles tendon and other tissues attach. Before this area fully matures, it can become sensitive to repeated pulling and impact.

Running, jumping, sprinting, and playing in cleats repeatedly load the heel. During a growth spurt, the bones may grow faster than the muscles and tendons adapt, increasing tension through the calf and Achilles tendon.

Contributing factors may include:

• A recent increase in practices, games, running, or conditioning

• Participation in running and jumping sports

• Rapid growth

• Tight calf muscles

• Limited ankle mobility

• Poorly cushioned or worn footwear

• Frequent activity on hard surfaces

• Inadequate recovery between sports sessions

Common symptoms

A child with Sever’s disease may report:

• Pain at the back or underside of one or both heels

• Pain that increases with running, jumping, or sports

• Tenderness when the sides or back of the heel are pressed

• Walking on the toes to avoid heel pressure

• Limping after practice or competition

• Symptoms that improve with rest but return with activity

• Calf tightness

Visible bruising and major swelling are less typical. If either is present—particularly after an injury—the child should be evaluated for another possible cause.

Does my child need an X-ray?

Sever’s disease is generally diagnosed through the child’s history and a physical examination. An X-ray cannot confirm Sever’s disease by itself.

A clinician may order imaging when the symptoms are unusual or when another condition—such as a stress fracture, cyst, or acute injury—needs to be ruled out.

Does the child have to stop playing sports?

Not necessarily, but “playing through it” without adjusting the workload can prolong or worsen the symptoms.

The appropriate activity level depends on how the heel responds. A useful rule is that participation should not cause significant limping, progressively increasing pain, or symptoms that remain worse the following day.

A temporary reduction in running and jumping may be needed. Lower-impact activities such as cycling or swimming can sometimes help the athlete maintain fitness while decreasing stress on the heel.

The goal is not simply to wait until the pain disappears. It is to identify the contributing load, restore mobility and strength, and gradually prepare the heel for the demands of the child’s sport.

What treatment may include

Treatment should be individualized, but commonly includes:

1. Adjusting activity

Reduce the amount or intensity of running, jumping, and cutting that aggravates the heel. This may mean modified practices rather than complete inactivity.

2. Supportive footwear

Well-fitting athletic shoes with appropriate heel cushioning may reduce irritation. A clinician may also recommend a temporary heel cup or heel lift.

3. Calf mobility

Gentle calf stretching may help when limited ankle motion or calf tightness increases tension on the heel. Stretching should be comfortable and should not be forced into significant pain.

4. Progressive strengthening

A rehabilitation program may include calf, foot, hip, and lower-extremity strengthening. Exercises should progress from controlled, lower-load movements toward running, jumping, and sport-specific activity.

5. Symptom management

Cold therapy may provide short-term pain relief after activity. Medication should only be used according to the child’s pediatrician or another qualified healthcare professional.

6. Gradual reloading

As symptoms improve, the child gradually rebuilds walking, running, jumping, and change-of-direction tolerance instead of returning immediately to a full sports schedule.

How long does recovery take?

There is no single recovery timeline. Some children improve within several weeks, while others require a few months—particularly when symptoms have been present for a long time or the sports workload has not been modified.

Symptoms can recur during another growth spurt or after a sudden increase in training. Sever’s disease generally stops recurring once the heel’s growth area has fully matured.

Rather than relying only on a calendar, return-to-sport decisions should be based on the child’s function.

Signs your child may be ready to progress

Before returning to unrestricted sport, the child should generally be able to:

• Walk normally without pain or limping

• Go up and down stairs comfortably

• Perform repeated heel raises with good control

• Jog without worsening symptoms

• Hop on the involved leg without significant pain

• Complete progressively faster running and direction changes

• Participate in a modified practice without increased symptoms later that day or the following morning

The demands of the child’s specific sport and position should also be considered.

When should you seek medical care?

Contact a pediatrician, sports medicine physician, orthopedist, or physical therapist if your child:

• Cannot bear weight normally

• Has severe or rapidly increasing pain

• Has substantial swelling, redness, or warmth

• Develops a fever

• Has pain at rest or during the night

• Experienced a fall or direct injury

• Has persistent pain on only one side

• Continues to limp

• Is not improving after reducing the aggravating activity

• Has symptoms that do not match the usual pattern of Sever’s disease

Where should parents start?

If you are unsure whether your child needs a physician, imaging, physical therapy, or simply an appropriate change in activity, begin with a pediatrician, pediatric sports medicine provider, or physical therapist experienced in treating young athletes.

The right evaluation can help determine whether the symptoms fit Sever’s disease, identify the factors contributing to the pain, and create a safe plan for returning to activity.

The objective is not only to calm the heel down. It is to help your child regain the mobility, strength, confidence, and activity tolerance needed to return safely to what they enjoy.

Michelle Starks, DPT is a Doctor of Physical Therapy with nearly 30 years of orthopedic rehabilitation experience across hospital, home-health, outpatient, and virtual care settings. Through TheOrthoDPT, she provides clear orthopedic education to help patients and families understand what may be happening, where to begin, and what to expect next.

This article provides general educational information and is not a diagnosis or an individualized treatment plan. Consult your child’s healthcare professional for recommendations specific to their condition.