Calcaneal Apophysitis (Sever's Disease)

Calcaneal apophysitis, commonly known as Sever's disease, is a condition that predominantly affects active children and adolescents during their growth spurts. This guide aims to provide a comprehensive understanding of Sever's disease, exploring its causes, symptoms, diagnosis, and effective management strategies. By shedding light on this often misunderstood heel condition, we empower parents, caregivers, and young individuals with the knowledge to recognize, address, and prevent Sever's disease.

Navigating the Basics of Sever's Disease

Defining Calcaneal Apophysitis

Calcaneal apophysitis, or Sever's disease, is not a true "disease" but rather an inflammation of the growth plate in the heel bone (calcaneus). This growth plate, known as the apophysis, is a vulnerable area where tendons attach to the heel.

Occurrence During Growth Spurts

Sever's disease typically emerges during the growth spurts of pre-adolescents and adolescents, commonly between the ages of 8 and 15 for girls and 10 and 17 for boys. The condition is often associated with increased physical activity.

Causes and Risk Factors

Overuse and Repetitive Stress

The primary cause of Sever's disease is repetitive stress and overuse of the heel bone during activities that involve running or jumping. The growth plate is sensitive to these stresses, leading to inflammation.

Physical Growth and Development

The rapid growth and development during adolescence can outpace the strengthening of the muscles and tendons, making the heel more susceptible to stress and injury. This imbalance contributes to the onset of Sever's disease.

Sports Participation

Participation in sports that involve running and jumping, such as soccer, basketball, and gymnastics, increases the risk of Sever's disease. The repetitive impact on the heel during these activities can exacerbate the condition.

Recognizing Symptoms of Sever's Disease

Heel Pain

The hallmark symptom of Sever's disease is heel pain, typically located at the back of the heel. The pain may be more pronounced after physical activities and may interfere with the child's ability to participate in sports.

Swelling and Redness

Inflammation of the growth plate can lead to localized swelling and redness around the heel. The affected area may feel warm to the touch, indicating an inflammatory response.

Limping or Walking on Toes

Children with Sever's disease may adopt a limp or prefer to walk on their toes to avoid putting pressure on the painful heel. This altered gait is a common adaptation to mitigate discomfort.

Diagnosing Sever's Disease

Clinical Examination

Healthcare providers typically diagnose Sever's disease through a comprehensive clinical examination, which includes evaluating the child's medical history, assessing symptoms, and performing a physical examination of the foot.

Imaging Studies

While imaging studies like X-rays are not always necessary for diagnosing Sever's disease, they may be employed to rule out other potential causes of heel pain and to confirm the condition in certain cases.

Differential Diagnosis

Distinguishing Sever's disease from other causes of heel pain, such as plantar fasciitis or Achilles tendonitis, ensures an accurate diagnosis and guides appropriate treatment.

Treatment Strategies for Sever's Disease

Rest and Activity Modification

Resting the affected foot and modifying activities that exacerbate symptoms are essential components of Sever's disease management. This may involve temporary cessation of sports or activities that place strain on the heel.

Ice and Anti-Inflammatory Medications

Applying ice to the affected heel helps alleviate pain and reduce inflammation. Additionally, over-the-counter anti-inflammatory medications may be recommended to manage discomfort and swelling.

Stretching and Strengthening Exercises

Physical therapy focusing on calf stretches and strengthening exercises can help address the muscle imbalances contributing to Sever's disease. These exercises aim to promote flexibility and enhance overall foot health.

Supportive Footwear and Orthotics

Proper Shoe Selection

Choosing supportive footwear with cushioning and good arch support is crucial for managing Sever's disease. Shoes with shock-absorbing properties can help reduce impact on the heel during activities.

Orthotic Inserts

Custom or over-the-counter orthotic inserts can provide additional support to the foot, addressing biomechanical issues and reducing strain on the growth plate. These inserts can be particularly beneficial during the recovery phase.

Gradual Return to Physical Activities

Monitoring Symptoms

As symptoms improve, a gradual return to physical activities is encouraged. However, close monitoring of symptoms is essential, and any recurrence of pain should be promptly addressed.


Diversifying physical activities and incorporating low-impact exercises, such as swimming or cycling, can help prevent overuse of the heel and reduce the risk of Sever's disease recurrence.

When Surgical Intervention Is Considered

Rare Occurrence

Surgical intervention for Sever's disease is extremely rare and only considered in cases where conservative treatments prove ineffective, and the pain persists despite exhaustive efforts.

Consultation with Specialists

If the condition becomes chronic or severe, consultation with pediatric orthopedic specialists may be sought to explore alternative treatment options, including surgical intervention.

Preventive Measures for Sever's Disease

Monitoring Growth and Development

Regular monitoring of a child's growth and development allows for early identification of potential risk factors. Awareness of growth spurts enables proactive measures to prevent the onset of Sever's disease.

Proper Warm-Up and Conditioning

Ensuring that children engage in proper warm-up routines and conditioning exercises before participating in sports activities helps prepare the muscles and tendons, reducing the risk of overuse injuries.

Education and Communication

Educating parents, caregivers, coaches, and young athletes about Sever's disease fosters a proactive approach to foot health. Encouraging open communication allows for early intervention and timely management.


In conclusion, Sever's disease is a temporary and treatable condition that affects the growing feet of active children and adolescents. By understanding the causes, recognizing symptoms, and implementing appropriate management strategies, parents and caregivers can play a crucial role in ensuring the well-being of young individuals experiencing heel pain. Through a combination of rest, supportive measures, and preventive strategies, Sever's disease can be effectively managed, allowing children to resume their active lifestyles with minimized discomfort and enhanced foot health.

The information on this website is provided for educational and information purposes only and is not medical advice. Always consult with a licensed medical provider and follow their recommendations regardless of what you read on this website. If you think you are having a medical emergency, dial 911 or go to the nearest emergency room. Links to other third-party websites are provided for your convenience only. If you decide to access any of the third-party websites, you do so entirely at your own risk and subject to the terms of use for those websites. Neither Mount Kisco Foot Specialists, PLLC, nor any contributor to this website, makes any representation, express or implied, regarding the information provided on this website or any information you may access on a third-party website using a link. Use of this website does not establish a doctor-patient relationship. If you would like to request an appointment with a health care provider, please call our office at (914) 666-7367.

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