Sever’s Disease Unpacked

Sever’s disease is an inflammation of the heel for active adolescents and as such is often known as calcaneal apophysitis. The heel itself contains a growth plate which is the lowest point of the heel and this area becomes inflamed leading to severe heel pain in the affected child or adolescent. This is a very common ailment for children and most cases of Sever’s disease occur in children aged between 8 and 15 years of age. At this stage of development children experience significant growth which can put a lot of stress on the heel in children who are extremely active, such as with sport. In particular children who regularly participate in sports that require a lot of running and jumping or indeed simply walking can develop heel pain if they have Sever’s disease.

There are several causes of Sever’s disease, but the main cause is the rapid growth of the adolescent. During puberty, children often go through a growth spurt of several inches in a short period of time. In many cases, the bones of the body grow faster than the muscles and tendons. The muscles and tendons of the heel will become stretched and placed under a lot of stress as a result of the growth of the calcaneus. Repetitive stress on the heel can cause inflammation of the heel, or a case of Sever’s disease. In addition to growth, the sudden increase in physical activity that many kids experience can place excessive stress on the heels and can cause Sever’s disease in some children.

Nieto-Gil et al. ( 2023) stated that Sever’s disease can affect any teenager but that those that participate in sports which require a lot of running and jumping such as basketball, football, soccer and even tennis are more susceptible to heel pain. Fares et al. ( 2021) explored the clinical and pathologic considerations of Sever’s disease and indicated how Sever’s can seriously affect the young athlete. They stated that Sever’s can affect any teenager with active lifestyles and who are in a phase of growth. The more active the adolescent the greater the likelihood that they will suffer from heel pain at some stage.

Scharfbillig and colleagues (2008) stated that the increasing incidence of Sever’s disease may be attributed to the rise in the number of children participating in organized sports at a young age. During sports, children are required to engage in physical activity for long periods of time, completing repeated bouts of exercise, such as training sessions. Children are expected to participate in physical activity for extended periods of time, and in recent years, young children are involved in organized sports at a very early age. It is not uncommon for children to be involved in organized sports from as young as four or five years of age. Many children participate in various sports on a regular basis, and as a result, they engage in a high level of physical activity. Children involved in sports are required to complete training sessions and participate in competitions, and are expected to perform at their best in order to succeed. During physical activity, children are required to complete repetitive movements, such as running, jumping, and sudden changing of direction. As a result of involvement in organized sports, children are at risk of developing various injuries, including those that affect the heel. The increased incidence of Sever’s disease in children may be attributed to the involvement of children in sports at a young age, and the high level of physical activity that they are required to complete.

Adolescents who are involved in sports or activities that demand a great deal of running, jumping, etc., can suffer from Sever’s disease. It is typical for adolescents to be involved in activity, or sport, while their heel is developing. It is no surprise to learn that the increased strain on the growth plates in the heel can cause them to lead to Sever’s disease, a painful and common condition affecting adolescents worldwide.

The symptoms of Sever’s disease can bring adolescents to a complete standstill. James et al. (2013) carried out a systematic review in order to find out more about the effects of calcaneal apophysitis on children and it was found that Sever’s disease causes children to participate in less physical activity. Many children with Sever’s suffer from heel pain and this can cause them to become isolated from their friends and become less physically active in sports. As sports are a large part of a child’s life, they can feel extremely left out. This can also have a large effect on the child’s social life. They may become withdrawn as they are no longer able to participate in the activities that they enjoy. Children with Sever’s are no longer able to be as active as they once were and this can cause frustration. The inability to take part in physical education lessons at school can cause feelings of embarrassment and this can affect a child’s overall school experience. As a result of this, a child with Sever’s may become less active and spend more time engaged in sedentary activities, and as a result, they may gain weight and develop poor fitness levels. This can have a very negative effect on a child’s life and as a result of this, it is very important to diagnose and treat Sever’s disease early in order to prevent these negative effects.

Chronic heel pain can affect young people’s participation in sports and in activities with their friends and family. The physical aspects of pain need to be managed but the impact of the pain on young people’s sense of self and on their well-being also needs to be acknowledged and addressed. As Ramponi and Baker (2019) outlined, there are many adolescents who experience chronic pain and Sever’s disease is one of those conditions that affects young people’s participation in and out of school. They report that they are frustrated because they are not able to participate in activities as other peers are and this affects their sense of self-esteem and sense of control. They report feeling helpless. The pain can also cause them to withdraw from sports and from social activities with their friends.

An Adolescent who has heel pain due to Sever’s disease will avoid physical activities such as running, jumping, dance etc, in attempt to relieve their pain and avoid further damage. While it is great that they are looking after themselves it can create huge problems in their social life. Physical activity and sports are a large part of an Adolescents life. They participate in team sports to maintain fitness and to have fun. As a result they form strong relationships with team members. They also enjoy participating in individual sports and taking part in physical activities with friends, in an attempt to maintain fitness, have fun and to be as active as possible. An Adolescent suffering from heel pain due to Sever’s disease will be forced out of activities such as these and will begin to avoid activities that may make their heel pain worse. As a result they will experience feelings of isolation, depression and frustration.

Moreover, pain from heel can prevent youngsters to engage in active sporting activities, and, conversely, be driven to more sedentary pastimes, with a subsequent risk of weight gain or very low levels of physical activity, thus generating a negative cycle of low sporting activity, pain from heel, stress and poor mental health with subsequent consequences for school performance.

The treatment of Sever’s disease is generally a conservative approach to ease heel pain so children can continue to be physically active while they are growing. While heel pain, stiffness, and swelling in the heel can affect a child’s life in many ways, recognizing the symptoms of the disease and how they can affect a child’s life is an important step in the treatment of Sever’s disease. Physical activity is an important part of growing up for children and adolescents, and helping children deal with heel pain while they are growing is an important step in management of the disease.

There are many ways Sever’s can be treated. This is usually on a conservative basis by various means of physical treatment to allow young active individuals to continue participate in activity, which is very important to them. Strengthening up of surrounding heel muscles by a program of stretching and strengthening exercises to ease pressure off the growth plate area as identified in a study by Hunt et al. (2007) are examples of physical treatment that help ease symptoms of Sever’s and therefore aid the individual’s activity levels.

Nweke (2025) described arch taping in the treatment of Sever’s disease. It is often used during sporting activities or for other periods of physical activity. He detailed how the tape could be placed on the foot to support the arch, thus to reduce heel pain that may occur during sporting activities or for any other reason. This method is a very simple method of support that can be put on the foot for physical activity and then taken off for any other activity, providing the user with good support during sporting or physical activities.

In addition to these treatments, there are many different shoes that can be worn to try to prevent or ease heel pain. There are many different types of heel pain and some of them may need special types of shoes in order to ease the pain. Some people find that they need custom orthotics in order to distribute the forces in the foot in order to ease the pain in their heel. In many different sports, the shoes that are worn can help to cushion the heel and to reduce stress and pressure on the heel in order to ease pain.

Becerro-de-Bengoa-Vallejo, et al. (2014) found that the evaluation of plantar pressures is key when treating Sever’s disease. This enables an adequate treatment to be put in place and the best results to be obtained. Children and adolescents suffering from heel pain are able to return to sport and physical activity with less discomfort when they receive the correct treatment for Sever’s disease.

In addition to treating the physical symptoms of Sever’s disease, there are also many ways to help adolescents cope with the related emotional challenges. Because so many young athletes deal with heel pain, it can be very helpful to share their experiences with others and receive support from others who are going through a similar situation. This can come from friends, family members, or even coaches.

In summary, adolescents with Sever’s disease are managed with a combination of physical therapy, taping of the arch, proper footwear, and the adolescents’ emotional management and support from their friends, family and coaches.

Citations:

Scharfbillig, R.W., Jones, S. and Scutter, S.D., 2008. Sever’s disease: what does the literature really tell us?. Journal of the American Podiatric Medical Association, 98(3), pp.212-223. https://braceworks.ca/wp-content/uploads/2015/07/sever1.pdf

Fares, M.Y., Salhab, H.A., Khachfe, H.H., Fares, J., Haidar, R. and Musharrafieh, U., 2021. Sever’s disease of the pediatric population: clinical, pathologic, and therapeutic considerations. Clinical medicine & research, 19(3), pp.132-137. https://www.clinmedres.org/content/19/3/132.short

James, A.M., Williams, C.M. and Haines, T.P., 2013. Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever’s disease): a systematic review. Journal of foot and ankle research, 6(1), p.16. https://link.springer.com/article/10.1186/1757-1146-6-16

Ramponi, D.R. and Baker, C., 2019. Sever’s disease (calcaneal apophysitis). Advanced emergency nursing journal, 41(1), pp.10-14. https://journals.lww.com/aenjournal/FullText/2019/01000/Sever_s_Disease__Calcaneal_Apophysitis_.3.aspx

Hunt, G.C., Stowell, T., Alnwick, G.M. and Evans, S., 2007. Arch taping as a symptomatic treatment in patients with Sever’s disease: a multiple case series. The foot, 17(4), pp.178-183. https://www.sciencedirect.com/science/article/pii/S0958259207000302

Nweke, T.C., 2025. Conservative Management of Sever’s Disease (Calcaneal Apophysitis): A Comprehensive Review of Treatment Efficacy. Cureus, 17(7). https://www.cureus.com/articles/391779-conservative-management-of-severs-disease-calcaneal-apophysitis-a-comprehensive-review-of-treatment-efficacy.pdf

Nieto-Gil, P., Marco-Lledo, J., Garcia-Campos, J., Ruiz-Munoz, M., Gijon-Nogueron, G. and Ramos-Petersen, L., 2023. Risk factors and associated factors for calcaneal apophysitis (Sever’s disease): a systematic review. BMJ open, 13(6), p.e064903. https://bmjopen.bmj.com/content/13/6/e064903.abstract

Gao, Y., Liu, J., Li, Y., Liu, Q. and Xu, S., 2020. Radiographic study of Sever’s disease. Experimental and Therapeutic Medicine, 20(2), pp.933-937. https://www.spandidos-publications.com/10.3892/etm.2020.8796

de Bengoa Vallejo, R.B., Iglesias, M.E.L., Sanz, D.R., Frutos, J.C.P., Fuentes, P.S. and Chicharro, J.L., 2011. Plantar pressures in children with and without Sever’s disease. Journal of the American Podiatric Medical Association, 101(1), pp.17-24. https://www.academia.edu/download/46498269/Plantar_pressures_in_children_with_and_w20160614-7306-1i2bxsp.pdf

Becerro-de-Bengoa-Vallejo, R., Losa-Iglesias, M.E. and Rodriguez-Sanz, D., 2014. Static and dynamic plantar pressures in children with and without sever disease: a case-control study. Physical therapy, 94(6), pp.818-826. https://academic.oup.com/ptj/article-abstract/94/6/818/2735591