Sever's Disease

Teenagers doing a lot of sport(s) are often prone to growth-related conditions, such as Sever’s Disease (calcaneal apophysitis). This condition arises due to repetitive stress on growth plates during periods of rapid skeletal growth, when demand on the tendons is large. Growth plates are the areas of new bone growth in adolescents, usually near the ends of long bones, such as the thigh or shin bone. Early recognition and treatment are essential to prevent long-term issues.

What is Apophysitis? 

Apophysitis is an overuse injury that occurs when there is inflammation at an apophysis (a growth plate where tendons attach to bones) typically seen in children and adolescents during periods of rapid growth and/or excessive activity.

Why does it happen? 

The early adolescent growth spurt causes bone growth to exceed that of the muscle-tendon unit. As a result, the muscle-tendon unit loses the ability to stretch sufficiently causing increased tension across the not yet fully grown (called ‘closed’ when finished growing) apophysis. This stress can irritate the growth plate causing inflammation and subsequently pain.

Sever's Disease

Sever’s Disease typically presents in children aged 8–14, especially those participating in running or jumping sports. It causes pain at the back of the heel where the Achilles tendon attaches to the calcaneus (heel bone). 

Symptoms include: 
  • Heel pain during or after activity.
  • Tenderness and swelling at the heel. 
  • Limping or difficulty walking barefoot.
Treatment includes:
  • Rest and Activity Modification: Avoid high-impact activities until pain subsides. 
  • Ice Therapy: Apply ice packs for 15–20 minutes after activity to reduce inflammation. 
  • Stretching and Strengthening: Focus on calf stretches, both with a straight leg and with bent knee to relieve tension on the growth plate. 
  • Supportive Footwear or Heel Pads: Shock-absorbing inserts can help distribute pressure.
Symptoms usually resolve with appropriate rest and rehabilitation, but recurrence is common during growth spurts.
Key Message:

Sever's disease is self-limiting and improves with conservative management, however it can recur with subsequent growth spurts. If your child is struggling with ankle pain, give us a call on 07702 847036 and speak directly to a Senior Chartered Physiotherapist or click the ‘Book Online’ button to make an appointment. Both in-clinic and virtual video appointments are available. We have two clinicians who treat children: Himanshu Sood (any age) and Sarah Massey (children aged 10 years and older).

The Nebula Physio and Wellbeing Team