Sever's disease is irritation of the growth plate at the back of the heel bone, and it is the most common cause of heel pain in active children. It is linked to repeated running and jumping while the heel is still growing. It is not a disease in the usual sense and tends to settle with sensible load changes, footwear support and exercise.
Also known as calcaneal apophysitis, heel growth plate pain, children's heel pain
Symptoms
- Pain at the back or bottom of the heel during or after sport
- Limping or walking on tiptoes after activity
- Pain when the sides of the heel are squeezed
- Stiffness first thing in the morning or after rest
- One or both heels affected
Causes and risk factors
- Repeated pulling of the Achilles tendon and impact on the heel growth plate
- High volumes of running and jumping, often on hard surfaces
- Growth spurts
- Reduced ankle flexibility (dorsiflexion) has been linked to it
- Higher body weight and foot posture may play a part
What the evidence says helps
- A systematic review of randomised trials found conservative care, including insoles, heel cups, exercise and taping, generally helps to relieve symptoms.1
- In a randomised trial of over 200 children, both heel lifts and custom foot orthoses reduced pain, with greater improvement in the orthoses group over 12 weeks.3
- Earlier evidence for heel raises and orthoses is limited and of low quality, so they are best used alongside load management rather than on their own.2
- Time away from sport can be significant – in one youth football academy the average return to play was around two months – so a planned, gradual return matters.5
- Ankle stiffness and foot alignment are the most studied risk factors, which supports calf flexibility work, although findings vary between studies.4
Things you can try at home
- Reduce running and jumping volume for a while rather than stopping all activity
- Wear supportive, cushioned trainers and avoid going barefoot on hard floors
- Try gel heel cups or a small heel raise in sports shoes
- Gentle calf stretches daily
- Ice the heel for 10–15 minutes after sport if sore
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- Heel pain after a fall or jump with inability to put weight on the foot – go to A&E or an urgent treatment centre
- A hot, red, swollen heel or a fever – see a GP the same day or call NHS 111
- Pain at night or at rest, or pain that keeps getting worse – see a GP
- Pain in a child under 7 or with no link to activity – see a GP to check for other causes
How Apollo can help
We assess your child's foot, ankle, footwear and sport schedule, explain what is going on and agree a plan to adjust load without losing all activity. Care may include calf and foot exercises, footwear advice, heel cups or orthotics where appropriate, and liaison with coaches. We refer to the GP if symptoms do not fit Sever's disease.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
Is Sever's disease serious?
No. Despite the name it is a common growth-related overuse problem. It usually settles over weeks to months and stops once the heel growth plate fuses in the teens.
Should my child stop sport with Sever's disease?
Not always. Most children can keep playing at a reduced level, using pain as a guide, with support from heel cups, footwear changes and exercises.
Do insoles help heel pain in children?
Trials suggest heel cups, heel raises and orthoses can reduce pain, with custom orthoses performing best in one large trial. They work best combined with load management.
References
- Hernandez-Lucas P, et al. (2024). Conservative treatment of Sever's disease: a systematic review. Journal of Clinical Medicine. View source
- James AM, et al. (2013). Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever's disease): a systematic review. Journal of Foot and Ankle Research. View source
- Alfaro-Santafé J, et al. (2021). Effectiveness of custom-made foot orthoses vs. heel-lifts in children with calcaneal apophysitis (Sever's disease): a CONSORT-compliant randomized trial. Children. View source
- Nieto-Gil P, et al. (2023). Risk factors and associated factors for calcaneal apophysitis (Sever's disease): a systematic review. BMJ Open. View source
- Belikan P, et al. (2022). Incidence of calcaneal apophysitis (Sever's disease) and return-to-play in adolescent athletes of a German youth soccer academy: a retrospective study of 10 years. Journal of Orthopaedic Surgery and Research. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
