Sever’s Disease (Calcaneal Apophysitis)

Overview

What is Sever’s disease?

Sever’s disease is a common condition that causes heel pain in children. The pain worsens during high-impact sports and activities that put pressure on a growth plate in the heel. Growth plates are pieces of cartilage between the bones of children and adolescents. As we age, growth plates harden into bone.

Also called calcaneal apophysitis, Sever’s disease is actually an injury, not a disease. Children outgrow it with time. In the meantime, symptoms usually get better with rest, pain medication and proper footwear. To relieve the pain, doctors recommend exercises to stretch the Achilles tendon that connects to the heel.

What’s the difference between Sever’s disease and Achilles tendinitis?

While Sever’s disease is irritation of the calcaneus bone, Achilles tendinitis is irritation of the tendon that attaches to the calcaneus bone. Unlike Achilles tendinitis, Sever’s disease only occurs in children and adolescents.

Why is it called Sever’s disease?

The condition is named after the physician who first described it in 1912: Dr. James Warren Sever.

How common is Sever’s disease?

Sever’s disease is extremely common. It is one of the most prevalent reasons for heel pain in kids aged eight to 14.

Who is affected by Sever’s disease?

Boys and girls from age eight to 14 most commonly have Sever’s disease. Boys are slightly more likely to develop the condition than girls. Groups with a higher risk of Sever’s disease include children and adolescents who:

  • Frequently run and jump, especially on hard surfaces.
  • Participate in high-impact sports, such as gymnastics, volleyball and basketball.
  • Are overweight or obese.
  • Wear shoes that don’t support their feet or aren’t appropriate for their activities.

Can adults have Sever’s disease?

No. Sever’s disease specifically affects children.

Additionally, pain caused by Sever’s disease is different compared to pain caused by other foot conditions. In general, heel pain in adults is reduced with activity. With Sever’s disease, activity tends to make the pain worse.

Symptoms and Causes

How do people get Sever’s disease?

Children develop Sever’s disease during a growth spurt, when the muscles, tendons, bones and cartilage grow quickly. As the bones and soft tissues grow and shift, they can be more vulnerable to injury.

Running and jumping puts stress on the Achilles tendon — the tough band of tissue that connects the calf muscle to the heel bone. This repeated stress causes swelling and pain in the growth plate where the Achilles tendon attaches to the back of the heel. As children age and the growth plate becomes solid bone, the heel and tendons can withstand more force.

What are the symptoms of Sever’s disease?

For children with Sever’s disease, the most common symptom is pain in the back of the heel. The pain can cause children to walk on their toes or walk with a limp.

The symptoms of Sever’s disease are similar to those of plantar fasciitis or shin splints, but the conditions aren’t related. Symptoms of Sever’s disease include:

  • Pain in one heel or both heels (most children report pain in both heels).
  • Tenderness and pain that gets worse with activities (especially jumping and running on hard surfaces) and improves with rest.
  • Redness, swelling and irritation in the heels.

How long does Sever’s disease last?

Sever’s disease can last until your child is fully grown. Once the growth plates close, the condition resolves itself.

Is Sever’s disease genetic?

There is no current evidence that suggests Sever’s disease is genetic. The condition is caused by repetitive stress to the heel.

Can Sever’s disease cause permanent damage?

No. Though Sever’s disease can be painful during the developmental years, it doesn’t cause long-term damage.

Diagnosis and Tests

How is Sever’s disease diagnosed?

Doctors diagnose Sever’s disease with a physical exam. Your child’s doctor will apply gentle pressure to the heel and foot to determine which specific areas are causing the pain. X-rays or magnetic resonance imaging (MRI) may help your doctor confirm a diagnosis and rule out other conditions, such as a fracture (broken bone).

How do I know if I have Sever’s disease?

If your child has heel pain, swelling and tenderness that gets worse with high-impact activities, it may be Sever’s disease. Because the symptoms of Sever’s disease can be similar to other conditions, your child should see a doctor to find the cause of the pain.

Management and Treatment

What are the treatments for Sever’s disease?

Symptoms of Sever’s disease often improve with home treatments like rest and over-the-counter pain relievers. It can take a few months for symptoms to disappear completely. Treatment for Sever’s disease includes:

  • Rest: Your child will need to take a break from vigorous activities for several days or weeks. Talk to your healthcare provider about how long your child should rest. Encourage your child to start activities gradually to prevent pain from returning.
  • Ice and pain relievers: Apply ice packs to the heel a few times a day for four or five days. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and swelling.
  • Supportive shoes: Ensure that 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.
  • Stretching exercises: Ask your healthcare provider or physical therapist for exercises that will stretch the Achilles tendon and reduce strain on the growth plate. Stretching and strengthening the heels, calves and hamstrings makes muscles stronger and better able to support the feet and heels.
  • Immobilization: If your child still has heel pain after a few weeks of rest, your healthcare provider may recommend a cast or splint to protect the growth plate and give it time to heal.

Physical therapy can be very beneficial for treatment of Sever’s disease. The therapist will set up specific exercises, like stretching, to help improve symptoms.

What are the side effects of treatment for Sever’s disease?

Side effects from NSAIDs can occur. They are rare and usually only affect people who have taken a medication for a long time. Side effects of NSAIDs can include:

What type of doctor treats Sever’s disease?

Your family physician or pediatrician may recognize the symptoms of Sever’s disease. If rest and treatment doesn’t resolve pain, or if your child has developed severe pain, you may be referred to an orthopaedic specialist.

Prevention

How can you prevent Sever’s disease?

It may not be possible to prevent Sever’s disease, especially in very active children. To reduce the risk of your child developing the condition, you can help your child:

  • Maintain a healthy weight: Children who are overweight or have obesity are more likely to have Sever’s disease. Encourage your child to eat healthy foods and stay active to keep their weight in the normal range.
  • Rest: Tell your child to take a break from activities if pain or swelling occurs. Children who give their bodies time to heal between activities have a lower risk of developing Sever’s disease.
  • Choose the right shoes: Children should wear supportive footwear that is appropriate for the sport or activity. Cleats can make symptoms worse because they put more pressure on the heel.
  • Vary activities: If your child participates in a lot of high-impact sports that involve running and jumping, mix in some low-impact activities. Swimming and bike riding will keep your child active while reducing stress on the heel bone.

Outlook / Prognosis

What is the outlook for patients who have Sever’s disease?

Most children and adolescents with Sever’s disease can manage their symptoms with conservative treatments. After children grow up, heel pain from Sever’s disease disappears when the growth plates turn into solid bone.

Living With

Can you play sports with Sever’s disease?

Your child shouldn’t participate in sports if they are in the middle of a flare-up. Use your best judgement and talk to your healthcare provider about which activities are safe for your child.

When should I call my healthcare provider about Sever’s disease?

If your child has heel pain and swelling, you should see your doctor. While Sever’s disease is not serious, your doctor will perform an exam and may order an X-ray to rule out other conditions, such as a fracture.

A note from Cleveland Clinic

Sever’s disease isn’t serious, but it can be quite painful for your child. If your child is showing Sever’s disease symptoms, schedule a consultation with your healthcare provider right away. Prompt diagnosis and treatment can help manage the condition until your child outgrows it.

Last reviewed by a Cleveland Clinic medical professional on 09/07/2021.

References

  • American Academy of Orthopaedic Surgeons. Sever’s Disease. (https://orthoinfo.aaos.org/en/diseases--conditions/severs-disease/) Accessed 9/22/21.
  • Gao Y, Liu J, Li Y, Liu Q, Xu S. Radiographic study of Sever's disease. (https://pubmed.ncbi.nlm.nih.gov/32742336/) Experimental and Therapeutic Medicine. 2020 Aug;20(2):933-937. Accessed 9/22/21.
  • Howard R. Diagnosing and treating Sever's disease in children. (https://pubmed.ncbi.nlm.nih.gov/25185924/) Journal of Emergency Nursing. 2014 Sep;22(5):28-30. Accessed 9/22/21.
  • Ramponi DR, Baker C. Sever's Disease (Calcaneal Apophysitis). (https://pubmed.ncbi.nlm.nih.gov/30702528/) Advanced Emergency Nursing Journal. 2019 Jan/Mar;41(1):10-14. Accessed 9/22/21.
  • Scharfbillig RW, Jones S, Scutter S. Sever's disease: a prospective study of risk factors. (https://pubmed.ncbi.nlm.nih.gov/21406697/) Journal of the American Podiatric Medical Association. 2011 Mar-Apr;101(2):133-45. Accessed 9/22/21.

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