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Sports injuries – Sever’s Disease in kids

Sever’s Disease in kids – why so many kids are experiencing heel pain

Rosemary Marchese – Physiotherapist

Sever’s Disease, otherwise known as calcaneal apophysitis, is inflammation of the growth plate in heels of growing children. It is more typical in very active adolescents when there is increased growing combined with repetitive stress to the heel. Usually it resolves when the bone has stopped growing or exercising stops. However, in most cases we don’t want the affected child to quit sport altogether so it’s a good idea to work out if there are any other causes. It is most common around 9-11 years of age and is not unusual for it to come back, especially if there are contributing factors that have not been managed.


Heel pain is usually the most prominent symptom and I usually diagnose it with the squeeze test. This means that the child will experience pain when I squeeze the inside and outside of their heel. Often the foot x-rays and ultrasounds are completely normal and therefore not warranted in many cases. The heel itself also looks normal so it’s a good idea to not ignore the symptoms just because there is no swelling or redness.


In some cases it is simply an overuse situation where there is plenty of running around and jumping during a time of growth. However, in many cases there are lots of other potential contributing factors that place extra stress on the heels. This can include overpronation of the feet, weak muscles around the hips, knees and ankles and often very tight hamstrings and calf muscles.


In our clinic treatment is geared towards reducing pain, minimising damage and preventing it from re-occurring. This involves using ice to reduce pain and dealing with the tight and weak muscles. I explain to the child what is happening and why they need to commit to exercises. This really helps because I find that children who come to the clinic are really committed to their home exercise program when they understand why they are doing the regime! In addition to the exercises we often perform some manual therapy and provide advice regarding return to sport.


Depending on the severity of the situation, most children take between 2-8 weeks to recover. Sever’s Disease is more common in boys than girls and I find that this is often related to the fact that many boys have tighter muscles than girls.

Preventing reoccurrence

There is a risk that Sever’s Disease may re-occur. It’s a good idea to:

  • maintain good flexibility
  • invest in good quality shoes
  • make sure the kids tie up their shoes properly so they are well fitted!
  • avoid excessive running on hard surfaces.

**At Max Sports Physiotherapy Clinic we run Stretch and Strength classes for kids. This has come about because of the large numbers of kids we see in our clinic with these types of injuries. Depending on your level of cover these classes may be health fund rebatable.