Sever's disease: heel pain with activity in children and adolescents

Sever's disease, also called Morbus Sever or calcaneal apophysitis, is an irritation in and around the growth plate at the back of the heel bone [1]. A British hospital information page points out that the condition is not truly a disease [3].

The Achilles tendon pulls on the area, which can cause small fractures and local inflammation [1].

The condition is most common in sports-active children between 8 and 15 years, during the growth spurt. It is rare in older teenagers, because the growth plate closes around the age of 15 [1].

The cause is overload in a period when the growth plate is vulnerable. Running and jumping increase the risk, and the symptoms often start after a new season, a new sport or periods of heavy loading [1]. A tight Achilles tendon pulling on the growth plate during a growth spurt is also mentioned [3].

The child has pain at the back of the heel that gets worse with activity and better with rest [1]. Some limp or walk on their toes [1][3]. It hurts when the sides of the heel are squeezed or when pressure is applied to the lower part of the Achilles tendon, and in about two out of three both heels are affected [1]. Sometimes there can be some swelling [3].

The diagnosis is made from the symptoms and tenderness when the heel is squeezed and pressed [1]. X-ray is usually unnecessary, but can show changes if the symptoms have lasted a long time [1].

NHI describes offloading from the activity that causes pain, while loading within the pain limit is fine. Cycling and swimming can be alternatives [1][3]. Ice after activity can be used when the pain is strong [1][3]. Regular stretching of the calf muscles is recommended, and a physiotherapist can give guidance [1][3]. Heel cups can be used for a period, only during activity [1]. Pain relief medicine is usually not necessary [1]. NHI also stresses that being with the team during breaks is important for the child [1].

A systematic review of nine studies found that orthoses with a heel cup and arch support gave more short-term pain relief than heel raises. Both orthoses and heel raises gave less pain than no treatment [2]. The authors describe the evidence as limited and of low quality. The effects of rest, ice and stretching individually have not been studied [2].

NHI describes the prognosis as good. Sport can usually be continued or resumed, often at a somewhat lower level while treatment is under way. The symptoms can last one to four years, but go away by themselves [1]. British hospital information states that the pain can take weeks to months to settle, and that it stops when growth is finished. It can return with later growth spurts [3].

British hospital information lists signs that should lead to prompt contact with healthcare professionals. These are regular or constant pain at night, swelling or bruising that does not improve, numbness or persistent pins and needles, a sudden limp with no known cause, fever or redness and heat at a joint, and the child being unable to walk on the leg. The same applies to pain that does not settle with rest [3].

A chiropractor can examine the heel and assess whether the pain fits with Sever's disease, and together with the child and parents make a plan that takes the activity level into account. At Dr.Dropin Bergen sentrum, children and adolescents can have Solemaids insoles fitted. The insoles have a recess that moves pressure away from the rearmost part of the heel. You can also read more about Sever's disease.

What is Sever's syndrome?

Sever's syndrome, or Sever's disease, is an irritation of the growth plate at the back of the heel bone. It causes heel pain with activity in growing children [1].

How long does Sever's disease last?

It varies. NHI states that the symptoms can last one to four years, but go away by themselves. British hospital information states weeks to months per episode, and that the pain stops when growth is finished [1][3].

Can the child play sports with Sever's disease?

NHI describes that loading within the pain limit is fine, and that sport can usually be continued or resumed, often at a somewhat lower level while treatment is under way [1].

Does the child need an X-ray for heel pain?

X-ray is usually unnecessary, since the diagnosis is made from symptoms and examination. It can show changes if the symptoms have lasted a long time [1].

The page about Sever's disease describes the condition on the clinic's own site, and the page about Solemaids explains the insoles. You can find more articles in the overview of articles.

This article was written by Dr.Dropin Fysikalske and is based on the sources listed below. It gives general information and does not replace an examination by a healthcare professional.

The websites were accessed and read on 22 October 2026.

1. Betennelse i hælsenefestet (Severs sykdom) (Inflammation of the heel tendon attachment, Sever's disease). NHI.no. Last updated 13 January 2023. Link

2. James AM, Williams CM, Haines TP. Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever's disease): a systematic review. J Foot Ankle Res. 2013;6:16. doi:10.1186/1757-1146-6-16. Link

3. Severs disease. Paediatric Physiotherapy, East Lancashire Hospitals NHS Trust. Patient information, date not stated. Link