Sever’s Disease (Heel Pain)

Sever’s Disease (Heel Pain)

Sever’s Disease is a painful condition of the heel (foot) that commonly presents in children and adolescents, commonly between 8 and 15 years of age. It is most common in males with a 2-3:1 ratio to females. (1) It is an overuse injury which develops overtime due to repetitive loading, often in highly active individuals. 

The injury occurs as the distal insertion of the Achilles tendon repetitively pulls (tractions) on the calcaneus (heel), causing secondary ossification (bony growth).  As such, this condition is often seen in adolescents as it coincides with rapid growth spurts and sudden increases in sporting activities. (2) Sporting activities are usually sporadic and high impact such as football, athletics, gymnastics and ballet. (3)

Diagnosis

Diagnosis does not require medical imaging e.g. X-Rays. Instead, it can be diagnosed by a trained health professional such as a physiotherapist. Physiotherapists can use a combination of assessments and subjective reports to assess and diagnose. Assessments include pain on palpation over the Achilles tendon, the squeeze test and range of motion of the foot and ankle. (4)

Treatment

Treatment of Sever’s requires a multi-faceted approach which can include a combination of the following: (5)

  • Activity Modification 
  • Education about pain management 
  • Anti-inflammatories
  • Foot Supports e.g. heel cups, heel lifts, taping or orthotics 
  • Strength-based Exercise to target any weaknesses or compensatory patterns 
  • Flexibility of lower limb

Prognosis:

In majority of cases, Sever’s disease is largely self-limited by pain and responds well with conservative treatment. Long-term consequences are rare and full recovery is usually achieved within 12 weeks. 

If your child is experiencing heel pain, feel free to contact us to learn more about how to form an evidence-based plan, specific to their goals.

  1. Sever’s Disease. (2021, February 25). Physiopedia, . Retrieved 09:21, March 23, 2021 from https://www.physio-pedia.com/index.php?title=Sever%27s_Disease&oldid=267703.
  2. Smith, J. M., & Varacallo, M. (2020). Sever Disease. In StatPearls. StatPearlsPublishing.
  3. Ramponi DR, Baker C. Sever’s Disease (Calcaneal Apophysitis). Adv Emerg Nurs J. 2019 Jan/Mar;41(1):10-14. doi: 10.1097/TME.0000000000000219. PMID: 30702528.
  4. Physio Works… n.d. Severs Disease – Physio Works…. [online] Available at: <https://physioworks.com.au/pain-injury/heel-pain/severs-disease/> [Accessed 21 March 2021].
  1. 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 May 3;6(1):16. doi: 10.1186/1757-1146-6-16. PMID: 23641779; PMCID: PMC3663667.