Sever’s disease: How to tell if your child’s heel pain is growing pains or something more

It’s normal for kids to feel some discomfort from growing pains and minor injuries as they grow up, especially if they participate in high-impact activities. But when pain shows up at the back of their heel, it could be a sign of Sever’s disease (calcaneal apophysitis). This may sound scary, but it’s actually a common condition that causes heel pain in children.

We’ll let you know how to spot the symptoms of Sever’s disease (named for the doctor who identified it in 1912), what you can do to treat it at home and when you should take your kiddo to see a doctor for their foot pain.

Sever’s disease only affects children. But what causes it?

Sever’s disease is caused by continued stress on the growth plate where the Achilles tendon attaches to the back of the heel bone. This stress causes pain and swelling in the child’s heel.

It’s very common for kids 8-14 years old, especially if they:

• Are overweight or obese
• Frequently run or jump on hard surfaces
• Participate in sports that are high impact on the heel, like basketball, track and field, or gymnastics
• Wear shoes that don’t properly support their feet

How do kids get Sever’s disease? And how long does it last?

Kids often get Sever’s disease during growth spurts because their bones, muscles and tendons are changing so rapidly. As these areas grow, they can be more at risk for injury. But while children can experience symptoms of Sever’s disease until they’re fully grown, the condition goes away once the growth plate closes.

Signs and symptoms of Sever’s disease

The most common symptom of Sever’s disease is pain in the back of the heel that forces the child to walk on their toes or with a limp. Other signs and symptoms include:

• Pain or tenderness in one or both heels that gets worse after activities like running or jumping
• Swelling or redness around the heel
• Discomfort or stiffness in the foot after sleeping

Sever's disease vs. plantar fasciitis

The main difference between Sever’s disease and plantar fasciitis is the area they impact. Sever’s disease causes pain in the back or sides of the heel because of growth plate inflammation. Plantar fasciitis causes pain at the bottom of the heel because of inflammation of the plantar fascia (the ligament that connects your heel to your toes). And Sever’s disease only affects children, while plantar fasciitis is more common in adults.

Sever’s disease irritates the calcaneus (heel) bone, but Achilles tendonitis irritates the tendon attached to the calcaneus bone. Sever’s disease only affects children and adolescents. And like plantar fasciitis, Achilles tendonitis is more common in adults.

How Sever’s disease is diagnosed

Your doctor will examine your child’s foot to see which areas are causing pain. They may also order an X-ray or MRI to confirm the diagnosis and rule out other conditions, like a fracture or broken bone.

Treatments for Sever’s disease

There is a wide range of treatment options for Sever’s disease. While some you can do at home to help manage your child’s symptoms, others require support from a podiatrist.

Rest and relax to give muscles a break

Sever’s disease symptoms often resolve themselves after some rest. Encourage your child to take a break from the sport or activity that is triggering the pain for a couple of days to weeks. Then have them slowly work their way back to their normal activities to prevent pain from returning.

Ice packs and over-the-counter medicine to reduce swelling

Apply ice packs to the heel a few times a day for 4-5 days. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen, can relieve pain and swelling.

Supportive shoes or heel cups to cushion the heel

Make sure your child wears shoes that support the arches and protect the foot. Cushioned heel cups can absorb shock and decrease the pressure on your child’s heels.

Physical therapy to stretch and strengthen muscles

Physical therapy can be very beneficial for treatment of Sever’s disease. Your child’s therapist will customize a routine of exercises and stretches to help relieve their symptoms. Stretching and strengthening the heels, calves and hamstrings will help make muscles stronger and better able to support the feet and heels.

A brace, cast or splint to immobilize the area

If your child still has heel pain after a few weeks of rest, your doctor may recommend a brace, cast or splint to help protect the heel’s growth plate and give it time to heal.

When to take your child to the doctor

Sever’s disease symptoms can usually be treated at home with rest and over-the-counter pain medicine. But if the problem persists, your child will need to see a podiatrist – a doctor that specializes in diagnosing and treating foot and ankle conditions. They’ll be able to confirm whether they have Sever’s disease or are experiencing another foot problem like a fracture or break.