What is Sever's disease?

Sever's disease is a common cause of heel pain in children. It usually first appears between 8 and 12 years of age, as this is when children are growing rapidly, and their bones are still growing. It is uncommon in children over 15 years of age, when their heel bones have finished developing.

Highly active children are most at risk.

The pain can come and go and usually lasts a few years, but generally doesn't lead to any long-term problems.

Sever's disease is also known as 'calcaneal apophysitis'.

What are the symptoms of Sever's disease?

Sever's disease may affect one or both feet. Symptoms can include:

• pain or tenderness in the heel, especially during or after exercise
• mild swelling around the heel bone
• limping

Symptoms are generally worse during or after exercise or physical activity. The symptoms usually get better with rest.

What causes Sever's disease?

When your child has a growth spurt, the bones, muscles and tendons (which attach muscles to bones) grow and change rapidly. The area of growth in bones (called the growth plate) is weaker than normal bone and is more likely to be injured.

When the bones in the lower leg (the tibia and fibula) grow quickly, the Achilles tendon (the large tendon that attaches the calf muscles to your heel bone) becomes tighter. This can add stress to the growth plate of the heel bone, causing it to become swollen and painful.

Exercise, such as running and jumping, puts extra pressure on the heel over the growth plate. Wearing sports shoes that have studs on the soles can also increase your child's risk of Sever's disease.

You can reassure your child that the pain will disappear when their heel bones stop growing.

When should I see my doctor?

Take your child to see your doctor or a physiotherapist if they are complaining of heel pain or you suspect they have Sever's disease.

How is Sever's disease diagnosed?

A doctor can diagnose Sever's disease by asking about your child's symptoms, including the area affected by pain and when it first started. They will also examine your child's feet.

Tests such as x-rays or blood tests are not normally needed to diagnose Sever's disease.

In some cases, your doctor may refer your child to a specialist.

How is Sever's disease treated?

Here are some steps your doctor or physiotherapist may recommend steps to reduce your child's symptoms:

• Rest and temporarily stop activities that cause heel pain.
• Use cold packs to reduce pain.
• Do calf stretches. Your physiotherapist can show you how to do these.
• Wear cushion pads in their shoes.
• Avoid sports shoes with stops (studs).

Living with Sever's disease

To ease the heel pain caused by Sever's disease, children may need to cut down on sports that involve lots of jumping and running, such as:

• basketball
• netball
• gymnastics
• Australian rules football
• athletics

They can usually continue with low-impact activities like swimming and cycling. It can also help to avoid use of shoes with studs.

Your child can return to their normal activities after the pain eases.

What are the complications of Sever's disease?

Sever's disease doesn't usually cause complications, though it can take between a few months and a few years to go away. The pain may come and go, but generally doesn't cause any lasting problems.

Can Sever's disease be prevented?

Sever's disease can't be prevented but avoiding sports that cause pain can help prevent flare ups.

Resources and support

Arthritis Australia has further information about the symptoms, cause, diagnosis and treatment of Sever's disease.

Call healthdirect on 1800 022 222 at any time to speak to a registered nurse (known as NURSE-ON-CALL in Victoria) for more information and advice.