Sever's Disease

Sever's disease is the most common cause of heel pain in kids aged 8 to 15 — and despite the name, it isn't really a disease. It's irritation at the growth plate at the back of the heel bone, where the Achilles tendon attaches. During the growth spurts of those years, the tendon and calf muscle can pull harder than the still-developing growth plate can comfortably handle. The good news: once the growth plate closes (skeletal maturity), it's gone for good.

It hits active kids hardest — especially soccer, basketball, gymnastics, and running. Pain shows up at the back of the heel, worse with sport and better with rest. On exam, gently squeezing the sides of the heel reproduces the pain (the squeeze test).

• Pain at the back of the heel — usually both heels, though one side can be worse than the other
• Pain that flares during and after running, jumping, or other high-impact sport
• Limping or walking on tiptoe to keep pressure off the heel
• Stiffness in the heel first thing in the morning or after sitting for a while
• Tenderness when you squeeze the sides of the heel (not the bottom)
• No swelling, bruising, or redness — Sever's looks normal on the outside

We diagnose Sever's from the story alone — heel pain in a growing child that flares with sport — and the squeeze test. X-rays usually aren't needed. When we do order them, it's mainly to rule out other causes of heel pain (a stress fracture, a foreign body, an infection) rather than to confirm Sever's itself.

1. NSAIDs / ice

   An over-the-counter anti-inflammatory like ibuprofen and ice on the heel after activity help with the immediate pain.

2. Physical therapy

   Once the acute pain settles, structured PT rebuilds calf flexibility and strength so the same pattern doesn't flare back as activity ramps up.

External patient-education references and related OSI pages for additional background:

• Britannica — Ankle (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language