Calcaneal apophysitis or Sever's Disease is a painful inflammation of the heel’s growth plate. It typically affects children between the ages of 8 and 14 years old, because the heel bone (calcaneus) is not fully developed until at least age 14. Until then, new bone is forming at the growth plate (physis), a weak area located at the back of the heel. When there is too much repetitive stress on the growth plate, inflammation can develop.

Sever’s disease is the most common cause of heel pain in children, and it can occur in one or both feet. Heel pain in children differs from the most common type of heel pain experienced by adults. While heel pain in adults usually subsides after a period of walking, pediatric heel pain typically gets worse.


Sever's disease is most common in kids who play sports due to overuse and stress on the heel bone. Muscle strain and inflammed tissue result from the repetitive movement and pounding that take place during sports play. For this reason, children and adolescents involved in soccer, track or basketball are especially vulnerable. Other potential causes of calcaneal apophysitis include obesity, a tight Achilles tendon and biomechanical problems, such as flatfoot or a high-arched foot.


Symptoms of calcaneal apophysitis may include:

  • Pain in the back or bottom of the heel
  • Limping
  • Walking on toes
  • Difficulty running, jumping or participating in usual activities or sports
  • Pain when the sides of the heel are squeezed
  • Tiredness


To diagnose the cause of your child’s heel pain and rule out other more serious conditions, Dr. Berg obtains a thorough medical history and asks questions about recent activities. He will also examine your child’s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.


Some of the common treatments for Sever's Disease include:

  • Reducing activity. The child needs to reduce or stop any activity that causes pain.
  • Supporting the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel.
  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
  • Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue.
  • Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile.

Often, heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.

Can Calcaneal Apophysitis Be Prevented?

The chances of a child developing heel pain can be reduced by:

  • A healthy diet to prevent obesity
  • Supportive shoes that are appropriate for the child’s activity
  • Avoid or limit wear of cleated athletic shoes
  • Avoid activity beyond a child’s ability.

For information about other types of heel pain visit:

What;s Causing My Heel Pain and What Can I Do About It?

If you suspect your child has Sever's disease call our office today at 206-368-7000 to make an appointment or request an appointment online