girls with soccer ballSever's Disease or calcaneal apophysitis is a common cause of heel pain in children. Unlike the heel pain known as plantar fasciitis that occurs in adults which is worse in the morning as dissapates with walking, walking usually makes the pain worse.


Overuse and stress on the heel bone through participation in sports is a major cause of Sever's Disease. When the heel plate has not fully closed which is common in boys 10-15 and girls 8-13, muscle strain and inflamed tissue can result particularly for kids involved in soccer, track, or basketball.

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, 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.


The surgeon may select one or more of the following options to treat calcaneal apophysitis:

  • Reduce activity. The child needs to reduce or stop any activity that causes pain.
  • Support 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

  • 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.

Call us today at 206-368-7000 for an appointment, often same day. You can also request an appointment online.