Sever’s Disease (Calcaneal Apophysitis)

Feb 26, 2018

Sever’s Disease (Calcaneal Apophysitis)

Sever’s Disease is a very common inflammatory condition that typically affects children between the ages of 8 to 14 years old.  During those years children are often going through many changes including rapid increases in bone growth (growth spurts).  Sever’s Disease is a condition that can affect both heels simultaneously or be isolated to one heel.

A Note to Parents:

The symptoms of Sever’s Disease may seem like typical growing pains.  In our fast-paced technological society it is common to turn to the internet for all kinds of answers.  The internet is a wonderful tool that can quickly provide valuable information but that information can be harmful without knowing the specifics of this ailment which only affects children.  Sever’s Disease is one of the most commonly searched medical conditions for children and heel pain on the internet.  To the untrained person, Sever’s disease can often be confused with similar adult conditions that also affect the heel.  There is an enormous volume of information on the internet, so please remember that children and adults are very different when performing your search and seek advice from trusted websites and physicians.

What Causes Sever’s Disease?

Stress and overuse of the heel bone (calcaneus) is the common cause of this condition.  It is very common for children who are active in sports to experience the symptoms of this condition; however, normal childhood activities and inappropriate shoes can cause it as well.

During the winter months with less daylight and cold temperatures, children often play either indoors or only during physical education class at school.  Usually these areas have surfaces that are hard (tile or concrete) and the repetitive pounding of the heel bone on these hard surfaces causes muscle strain and inflammation around the heel.

Oftentimes the symptoms of Sever’s Disease are not identified until your child returns to their Spring sports or becomes more active outdoors with the longer days and warmer temperatures.  With the gradual onset of the inflammation over the Winter months your child adapts by placing less pressure on their heels.  Once their activity level increases, the pain and discomfort become more obvious not only to the child but also to the untrained eye.  See the common symptoms below.


  1. Limping
  2. Walking on their toes
  3. Pain in the back or bottom of the heel
  4. Difficulty running, jumping or participating in their usual activities or sports
  5. Pain with squeezing the heel bone

In some instances an athletic coach may notice that a child is not giving one hundred percent effort during practice or in a game.  If the child has not communicated that they are experiencing any pain or discomfort this behavior can be misinterpreted as loafing or disinterest.  Coaches push their players to hustle and without accurate information they can easily pass negative judgement.  Be sure to establish a clear and honest line of communication with your child regarding their health and convey any issues that are limiting your child’s ability to their coaches.

Diagnosing Sever’s Disease:

If your child is complaining of foot and/or heel pain, you should have them evaluated by a podiatrist (a physician specializing in the foot, heel and ankle).  With a thorough medical history and physical examination we can identify or rule out other more serious causes of your child’s heel pain.   X-rays are commonly used to evaluate your child’s feet to identify other conditions such as fractures or bone abnormalities.  Sometimes additional testing will need to be performed such as laboratory tests or advanced imaging studies (MRI, CT Scan).

Treatment of Sever’s Disease:

There are multiple treatment options for Sever’s Disease.  Once a thorough examination has been completed a detailed plan of care will be recommended that is tailored to suite your child.  Some examples of treatment include: immobilization with either a cast or a pneumatic walking boot.  Treatment may also include the use of orthotics for control and support, medications, temporary modification of activities, or physical therapy.

Tips to help prevent Sever’s Disease:

This condition is sometimes inevitable due to the activity and growth of your child.  A few recommendations we have for parents are:

  1. Make sure your child wears appropriately fitting and supportive shoes. Especially when your child is around the house since most homes have either tile, cement or hardwood floors in high traffic areas.
  2. Make sure your child is appropriately stretching prior to performing strenuous activity as well as after the activity. Calf stretches are particularly important.  Ask us for appropriate stretches for your child.
  3. Please remember if your child starts to complain or you notice any of the above symptoms seek treatment as soon as possible.  Receiving care sooner rather than later can dramatically reduce both the severity and time of their treatment. We are here to get them back into their favorite sport or activity as soon as possible.

Here at Waco Foot & Ankle and Heart of Texas Heel Pain Center, we specialize in diagnosing, treating and educating patients on all conditions affecting the toes, feet, heels and ankles.  We have gone through specialized training so that we can deliver the highest level of advanced care to these areas of the body.  Our goal is to have each patient return to the activities they love but have had to limit due to pain or other limiting factors as quickly as possible.  In some instances a surgical procedure is the best option for treating a certain condition but there are often many noninvasive/nonsurgical treatments and therapies we can trust to bring an end to your pain and resolve your condition.

Remember, pain is not normal.  If you are suffering from foot pain, heel pain or ankle pain you need to be evaluated by a specialist.

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Click here to learn how is childhood obesity related to Sever’s Disease?

Click here for more information on Sever’s Disease from the American College of Foot & Ankle Surgeons

Click here for more information on Children’s Foot Conditions we treat

Click here to visit the Waco Foot & Ankle site

Click here to visit the Heart of Texas Heel Pain Center site


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