Sever's Disease or calcaneal apophysitis is a common cause of heel pain in children. While plantar fasciitis is worse in the morning and gets better with walking, walking usually make the pain of Sever's Disease worse. 


Children who play sports are most at risk for Sever's Disease through overuse and stress on the heel bone. When the heel plate has not fully closed, muscle strain and inflamed tissue can result particularly for kids involved in soccer, track, or basketball. This is commonly found in boys 10-15 and girls 8-13.

Other potential causes of Sever's Disease include obesity, a tight Achilles tendon, and biomechanical problems such as flatfoot or a high-arched foot.


Symptoms of Sever's Disease 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


To diagnose the cause of your child’s heel pain and rule out other more serious conditions, our podiatrist will obtain a thorough medical history and ask 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.

Fortunately, Sever's Disease does not cause any long term foot problems.

Treatment of Sever's Disease in North Seattle

The following treatments are used to treat Sever's Disease.

  • Reducing or stopping any activity that causes pain will go a long way in treating this condition. Once activity starts again, playing time should be increased gradually.
  • Using over-the-counter shoe inserts such as Powersteps or custom orthotics can provide support for the heel.
  • Using nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen,to help reduce the pain and inflammation.
  • Stretching tight calf muscles and strengthing exercises with a physical therapist can promote healing of the inflamed issue.
  • Using a cast to keep the foot from moving may be required in cases of severe heel pain. 

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 Sever's Disease, 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 Sever's Disease Be Prevented?

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

  • Reducing their risk for obesity
  • Choosing well-constructed, supportive shoes that are appropriate for the child’s activity
  • Avoiding or limiting cleated athletic shoe wear
  • Avoiding activity beyond a child’s ability.
Dr. Rion Berg
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A podiatrist in North Seattle treating families for over 40 years.