Sever's Disease (Heel pain in children)



Sever's Disease is a traction apophysitis of calcaneal tuberosity. In the specific apophysitis is a painful irritation and inflammation of the apophysis (the growth plate). The growth plate is made up of cartilage, which is softer and more vulnerable to injury than mature bone. The growth plate usually fuses by age 15-16. Sever's Disease is the most common cause of heel pain in physically active children, and it is usually seen in soccer, basketball and gymnastics.



Tightness of the Achilles Tendon or calf muscles, leading to increased pressure on the growth plate.

High impact activities.

Poor fitting shoes

Growth spurt


Sever’s disease is more common in boys. They tend to have later growth spurts and typically get the condition between the ages of 10 and 15. In girls, it usually happens between 8 and 13

The most obvious sign of Sever's disease is pain or tenderness in one or both heels, usually at the back. The pain also might extend to the sides and bottom of the heel, ending near the arch of the foot. 

The main diagnostic tool is pain on medial-lateral compression of the calcaneus in the area of the growth plate (figure below).

X-Ray is indicate with acute traumatic injury/onset.

                                                  Figure 2. The squeeze test. Medial-lateral compression of the calcaneal growth plate to elicit pain in Sever's disease.  



Rest (1-2 weeks  usually sufficient).

Proper fitting shoes.

Heel pad or orthotic heel support (should be wear bilaterally, to avoid causing leg lenght asymmetry).

Gently stretch plantar fascia and calf muscles.

Massage calf muscles. 

Consider deep water exercises in difficult cases.



Scharfbillig, Rolf & Jones, Sara & Scutter, Sheila. (2008). Sever’s Disease: What Does the Literature Really Tell Us?. Journal of the American Podiatric Medical Association. 98. 212-23. 10.7547/0980212. 



Dott. Emanuele Luciani
Osteopathphysiotherapist, hatha yoga teacher
Osteopath registered with the General Osteopathic Council (GOsC)
(number 8232
 "Centro Studi Tre Fontane"
Via Luigi Perna 51, Rome


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Friday, 19 July 2024
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