Heel pain in athletes during rapid growth spurts is often as a result of a condition called Sever’s disease, also known as calcaneal apophysitis. While it sounds scary, it’s actually a common and usually temporary issue that affects the growth plate in the heel of active children and teens. Typically, it shows up during periods of rapid growth and high activity levels, such as soccer, basketball, gymnastics, or track. Left unchecked, it can limit running, jumping, and tumbling, but understanding the causes, symptoms, and recovery strategies can help young athletes stay active and pain-free.
What Is Sever’s Disease?
Despite the common name, Sever’s disease isn’t really a “disease,” it is more accurately a bone and tendon injury. It’s an inflammation at the bony landmark where the calf muscles attach to the back of the heel. It occurs in children and adolescents, usually between ages 8 and 14.
Bones tend to grow faster than tendons and muscles. That means that during periods of rapid growth two things occur: 1. The tendons attaching to the back of the heel shorten in comparison to the growing bones and put a higher strain on the attachment point. 2. The body weighs more and the tenons have not yet had enough time to adapt to the new weight and are more prone to tendon overuse. When a child participates in sports that involve running, jumping, or sudden changes in direction, the Achilles tendon pulls on the growth plate. This can cause irritation, pain, and swelling in the heel. Often pain from Sever’s disease is temporary (1-2 months), because given enough time the length and strength of the athletes’ tendons will adjust to their new body. However, sometimes Sever’s disease results in achilles tendonitis, which will need specific treatment for improving.
Common Symptoms
Symptoms of Sever’s disease often include:
- Posterior heel pain during or after activity, especially running, jumping, or tumbling.
- Tenderness at the back or bottom of the heel, sometimes on both feet.
- Localized swelling in the back of the heel.
- Limping or avoiding high-impact movements to reduce discomfort.
- Tight calves or Achilles tendon, which may worsen stress on the heel.
Sever’s disease rarely causes bruising or severe swelling. Pain is usually activity-related and may come and go depending on daily activity levels.
Risk Factors for Sever’s Disease
Certain factors can increase the likelihood of developing Sever’s disease:
- Rapid growth spurts – When bones grow faster than muscles and tendons, the heel can become tight and more prone to stress.
- High-impact sports – Soccer, basketball, gymnastics, track, and other sports with running and jumping increase the load on the heel.
- Inadequate strength in calf muscles or Achilles tendon for dealing with increased body size or amount of training – Continuing the strengthening of the calf muscles throughout a growth spurt can help speed up the adaptation process and prevent overloading of the tendon.
- Improper footwear or foot stability – Shoes with poor cushioning or poor body mechanics may fail to absorb impact adequately and place increase strain on an athlete’s achilles tendon.
- Flat feet or high arches – Foot structure can change how forces are distributed during activity, affecting the heel.
Treatment and Recovery
The good news is that Sever’s disease usually resolves with conservative treatment and proper care:
Be Warm or Be Torn!
- Always adequately warm up your calf muscles through full pointing and flexing range of motion with low level strain, such as double leg calf raises, before activity. This improves the strength and elasticity of muscles and tendons to decrease the risk of injuring them.
Activity Modification
- Reduce high-impact when possible. Follow the 10 Minute Rule, any activity that flares up symptoms more than 10 minutes is too aggressive. Always let symptoms return to baseline before completing a new activity.
Supportive Footwear, inserts, or taping
- Cushioned shoes or heel cups can reduce impact and protect the heel during activity. For barefoot sports, KT tape or athletic tape can be used to create similar support.
Strength and Balance Exercises
- Encourage exercises that strengthen the lower leg and improve overall balance, which can prevent compensatory movements that aggravate pain.
Gradual Return to Sport with the 10 Minute Rule
- Slowly reintroduce running, jumping, and sport-specific movements as pain decreases. It is normal and required to complete exercises that increase pain on the way to recovery, but if an athlete is flared up more than 10 minutes than the exercise is too aggressive for their stage of recovery.
When to See a Professional
- If pain persists without significant improvement within 3 weeks then a good sports physical therapist can assess for additional issues and guide a tailored recovery plan. If pain persists more than 5-6 weeks, it should be considered achilles tendonitis and is less likely to resolve without targeted treatment.
Growing Stronger, Pain-Free
Sever’s disease can be frustrating for young athletes, but with proper care most children return to full activity without long-term issues. Parents and coaches can help by encouraging proper warm up, limiting high impact activity levels, following the 10 MInute Rule and ensuring proper foot and heel support for assistance when needed.
If your child is struggling with heel pain, early intervention is the best way to prevent setbacks and keep them active, happy, and healthy.