Calcaneal Apophysitis: Sever's Disease

Calcaneal Apophysitis, Severs Disease, Univeristy Foot and Ankle Institute

Also known as Sever’s disease, Calcaneal Apophysitis presents as heel pain and is caused by an inflammation of the heel’s growth plate. A growth plate is the cartilaginous part of the end of a growing bone. Over time, the cartilage cells transform into hardened bone cells, forming a fully-mature length of bone.


University Foot and Ankle Institute's physicians have been successfully treating pediatric patients for over 20 years. They pride themselves in offering the very best care in a relaxed, compassionate and patient environment.

Calcaneal Apophysitis Causes

Sever’s disease occurs when the growth of the heel bone rapidly outpaces the growth of the leg muscles and tendons. This can happen during the growth spurts brought on by puberty, usually hitting girls between 8-13 years and boys between ages 10-15.


The Achilles tendon, pulled tight by the tension exerted from the growth of the heel, can damage the growth plate, causing inflammation, swelling, and pain in the heel. The repeated strain of physical activity exacerbates the pain, which is why Sever’s disease most commonly affects young athletes.



Symptoms of Calcaneal Apophysitis

Symptoms can manifest in both heels or in just one. Some common signs and symptoms include:

  • Pain, swelling, redness, and tenderness in the back of the heel
  • Pain in the sides or bottom of the heel
  • Pain that is exacerbated by activity, then subsides with rest
  • Discomfort and stiffness while walking
  • Limping or tiptoeing to avoid heel pain
  • Pain when squeezing the heel between two fingers



Risk Factors for Calcaneal Apophysitis

Calcaneal apophysitis can affect any child, but some children are at an increased risk.

  • Physically active. Sever’s is fairly common among young gymnasts, runners, soccer players and basketball players. Children who spend a lot of time running and jumping, especially on hard surfaces, are much more susceptible because their activities repeatedly strain the already-overstretched Achilles tendon. The tendon pulls on the heel, irritating the cartilaginous growth plate.
  • Improper shoes. Ill-fitting shoes or shoes that rub on the back of the heel can lead to calcaneal apophysitis.
  • Flat feet or high arches. Both flat and high arches can affect the foot’s mechanics and the way the Achilles tendon pulls on the heel.
  • Pronation. Pronation is a term used to describe the inward rotation of the ankle while walking. While some pronation is typical, over-pronation can cause tightness in the Achilles tendon.
  • Short-leg syndrome. If one of your child’s legs is shorter than the other, the heel of the shorter leg has to work harder to hit the ground. This can cause strain on the Achilles tendon, which pulls harder on the growth plate of that foot.
  • Extra weight. Children who are overweight or obese may be at an increased risk because their weight can put excessive pressure on the growing heel.



Treating Calcaneal Apophysitis

If your child is experiencing pain or having difficulty walking, please make an appointment with us. Your foot and ankle specialist will examine your child’s feet and take note of his or her symptoms. The doctor may squeeze your child’s heel from both sides or have your child stand on tiptoes to check for sources of pain. X-rays may be ordered to rule out any other possible problems, such as an acute injury.


Though there are several ways to treat the symptoms of Sever’s disease, the only “cure” for the condition is to outgrow it. It may take up to two years for your child to complete his or her growth spurt. In the meantime, your child can manage the pain by:

  • Resting. Your pediatric foot and ankle specialist will likely recommend cutting back on physical activities that involve running and jumping. Your child may be able to stay active by swimming, cycling, rollerblading, or playing sports that put less strain on the Achilles.
  • Stretching the leg muscles. Your foot and ankle specialist can demonstrate a few exercises that can help stretch and strengthen the Achilles.
  • Wearing elastic wraps or compression socks. These can reduce discomfort and swelling in the heels. Ask your foot and ankle specialist for brand recommendations.
  • Icing and elevation. Wrap an ice pack in a cloth and apply to the heel for 15 minutes, three times per day. You should do this even on days when your child doesn’t complain of pain. Icing combined with elevation can cut down on swelling.
  • Taking oral medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can reduce pain and inflammation.


Sometimes, a patient’s case is so severe that it requires a more intensive approach. Your foot and ankle specialist may recommend:

  • Orthotic inserts. These are custom-fitted padded insoles that alleviate pressure from the heel, distributing it over a larger area of the foot. This can relieve the strain on your child’s heel, reducing pain and giving your child’s foot a better chance to heal.
  • Physical therapy. Physical therapy techniques can decrease the inflammation.
  • Immobilization. If your child’s case is very severe, your UFAI specialist may put the ankle in a boot or cast to immobilize the foot and allow the growth plate to heal.



Recovering from Sever's Disease

With rest and proper treatment, most cases of Sever’s disease will improve within 2-8 weeks. Although your child may be reluctant to stop playing his or her favorite sports, it’s important to get rest and treat the symptoms sooner rather than later. The sooner you seek treatment, the quicker the recovery. Fortunately, there are no lasting negative effects for your child as he or she grows into young adulthood.


Calcaneal apophysitis may return if steps are not taken to support the heel and protect the growth plate from stress. Make sure your child is wearing supportive, well-fitted shoes with shock-absorbing soles to cushion the heel from repeated impact. For casual, everyday wear, we recommend buying your child shoes without backs, such as sandals or clogs, so that the heel has room to expand and move.


Heel pads, heel lifts, and/or arch supports are a good idea for long-term foot health. Check in with your foot and ankle specialist about the right orthotics for your child.

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