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Football Fever

Hard ground and “football fever” combine to make life difficult for sporty children.

Limping from a painful heel is most likely to be Severs’ Disease. Not a disease at all, but a “growing pain” that can be very frustrating, with long periods “off-games”.

At the London Foot and Ankle Centre we assess and treat youngsters struggling with this complaint.

We are proud to be the UK’s foremost centre for Solemaids insoles – an innovative solution from Denmark. Solemaids insoles have helped make thousands of children (and parents) happy and able to continue their activities.

Understanding Sever’s Disease: A Comprehensive Guide for Patients


Sever’s disease, also known as calcaneal apophysitis, is a common condition affecting children and adolescents, particularly those who are active in sports. It is a type of osteochondrosis. This means it is a problem involving the growth plates of bones. This is why it selectively affects growing children.

Sever’s disease specifically impacts the growth plate in the heel bone, causing pain and discomfort.

This guide aims to provide a thorough understanding of Sever’s disease, including its causes, symptoms, diagnosis, treatment options, and preventive measures.

What is Sever’s Disease?

Sever’s disease occurs when the growth plate in the heel bone (calcaneum) becomes inflamed. The growth plate, also known as the physis, is a layer of soft cartilage located near the ends of bones in growing children. This cartilage layer produces new bone, for growth. It is softer and more vulnerable to injury than mature bone. In Sever’s disease, the repetitive stress and pressure on the heel, often from physical activities, lead to inflammation and pain.


Causes of Sever’s Disease

The primary cause of Sever’s disease is overuse and repetitive stress on the heel bone, particularly during periods of rapid growth. Several factors contribute to the development of this condition:

  1. Physical Activity: Sports that involve running, jumping, or repetitive heel strikes, such as soccer, basketball, and gymnastics, put significant stress on the heel bone’s growth plate.
  2. Rapid Growth Spurts: During a growth spurt, the bones, muscles, and tendons grow at different rates. The heel bone may grow faster than the surrounding muscles and tendons, leading to increased tension and susceptibility to injury.
  3. Biomechanical Factors: Certain foot structures, such as flat feet or high arches, can alter the distribution of stress on the heel, increasing the risk of developing Sever’s disease. High body weight can play a part too.
  4. Improper Footwear: Shoes that do not provide adequate support or cushioning can exacerbate the strain on the heel bone, contributing to the development of Sever’s disease.

Symptoms of Sever’s Disease

The hallmark symptom of Sever’s disease is heel pain, which typically presents as follows:

  1. Pain in the Heel: The pain is usually located at the back or bottom of the heel. It can be mild to severe and often worsens with physical activity. Sometimes it is mistaken for Achilles tendon pain or plantar fasciitis (“Policeman’s Heel”).
  2. Tenderness: The heel may be tender to touch, particularly when pressure is applied to the back of the heel or the heel squeezed side-to-side.
  3. Swelling: Mild swelling around the heel may be present.
  4. Limping: Children with Sever’s disease may walk with a limp or avoid putting weight on the affected heel to alleviate pain.
  5. Stiffness: There may be stiffness in the heel, particularly in the morning or after periods of rest.

Diagnosis of Sever’s Disease

Diagnosing Sever’s disease involves a combination of medical history, physical examination, and, in some cases, imaging studies:

  1. Medical History: Your doctor will inquire about the child’s symptoms, activity level, and any recent growth spurts.
  2. Physical Examination: The doctor will examine the heel for tenderness, swelling, and pain. They may also assess the child’s gait and foot structure.
  3. Imaging Studies: While Sever’s disease is primarily diagnosed clinically, X-rays may be taken to rule out other conditions, such as fractures or infections. X-rays typically show normal bone structure in Sever’s disease, as the condition affects the growth plate rather than the bone itself.

Treatment of Sever’s Disease

Treatment for Sever’s disease focuses on relieving pain, reducing inflammation, and allowing the growth plate to heal. The following approaches are commonly used:

  1. Rest: Limiting or modifying physical activities that exacerbate heel pain is crucial. Complete rest may not be necessary, but reducing high-impact activities is recommended.
  2. Ice Therapy: Applying ice packs to the affected heel for 15-20 minutes several times a day can help reduce pain and inflammation.
  3. Pain Relief: Over-the-counter pain relievers, such as ibuprofen or paracetamol, can help manage pain and reduce inflammation.
  4. Stretching and Strengthening Exercises: Stretching exercises for the calf muscles and Achilles tendon can help alleviate tension on the heel. Strengthening exercises for the foot and ankle can also be beneficial.
  5. Physical Therapy: In some cases, a physical therapist may be recommended to design a tailored exercise program and provide additional therapies to aid recovery.
  6. Proper Footwear: Ensuring that the child wears supportive and well-cushioned shoes can help reduce stress on the heel.
  7. Heel Pads and Orthotics: Cushioned heel pads or orthotic inserts can provide additional support and reduce stress on the heel.
  8. Specialised Insoles: Solemaids insoles are a newer method to help enable children to remain active (

Prevention of Sever’s Disease

Preventing Sever’s disease involves minimising the risk factors that contribute to its development. The following strategies can help:

  1. Gradual Increase in Activity: Encourage children to gradually increase the intensity and duration of physical activities to allow their bodies to adapt.
  2. Proper Footwear: Ensure that children wear shoes that provide adequate support, cushioning, and fit properly. Replace worn-out shoes promptly.
  3. Stretching and Strengthening: Incorporate regular stretching and strengthening exercises for the calf muscles, Achilles tendon, and foot muscles into the child’s routine.
  4. Balanced Activities: Encourage participation in a variety of physical activities to avoid overloading the heel with repetitive stress from a single sport.
  5. Weight Management: Maintaining a healthy weight can reduce excessive stress on the heel.

When to See a Doctor

While Sever’s disease is a self-limiting condition that typically resolves with proper management, it is essential to seek medical attention if:

  1. Severe Pain: The child experiences severe heel pain that does not improve with rest and home remedies.
  2. Persistent Symptoms: Symptoms persist for an extended period, even with treatment.
  3. Difficulty Walking: The child has difficulty walking or exhibits significant limping.
  4. Other Concerns: There are any other concerning symptoms, such as redness, warmth, or fever, which may indicate an infection or other condition.

Long-Term Outlook

The prognosis for Sever’s disease is excellent. All children outgrow the condition as the growth plate matures and hardens into bone, usually around the ages of 14-16 for girls and 16-18 for boys. With appropriate treatment and management, the symptoms can be effectively controlled, allowing children to continue participating in their favorite activities.

There are no problems seen later amongst adults who suffered from Sever’s in adolescence.

Coping with Sever’s Disease

Coping with Sever’s disease can be challenging for both the child and their family. Here are some tips to help manage the condition:

  1. Educate and Communicate: Educate the child about the condition and its management. Open communication with coaches, teachers, and other caregivers can ensure that the child’s needs are met.
  2. Modify Activities: Find alternative low-impact activities that the child can enjoy without exacerbating heel pain, such as swimming or cycling.
  3. Encourage Patience: Emphasise the importance of rest and proper treatment to the child. Encourage patience, as the condition heals over time.
  4. Monitor Progress: Keep track of the child’s symptoms and progress. Regular follow-ups with the doctor can help ensure that the treatment plan is effective.


Sever’s disease is a common and manageable condition that affects the heel bone’s growth plate. It frequently affects active children and adolescents. Understanding the causes, symptoms, diagnosis, and treatment options is essential for effective management and recovery. By following preventive measures and adhering to a proper treatment plan, children with Sever’s disease can continue to lead active and healthy lives.

If you suspect that your child may have Sever’s disease, consult the London Foot and Ankle Centre for a comprehensive evaluation and personalised treatment plan. 

Bibliography of scientific articles:

Research on Sever’s disease has explored various aspects, including its aetiology, diagnosis, treatment, and prevention. Here are some key research articles and sources that have significantly contributed to the understanding of Sever’s disease:

  1. Etiology and Pathophysiology:

    * James A. Micheli and Lyle J. Ireland (1987): “Prevalence of Sever’s Disease in Children”. This study examines the frequency and contributing factors of Sever’s disease in a pediatric population.
    * Volker Schmitz et al. (2013): “Calcaneal apophysitis (Sever’s disease): A critical analysis focusing on etiology”. This review critically analyzes the potential causes and contributing factors of Sever’s disease.
  2. Clinical Presentation and Diagnosis:

    * Michael J. D. Jones et al. (2015): “Clinical symptoms and physical examination findings in children with Sever’s disease”. This article provides a comprehensive overview of the clinical presentation and common physical examination findings in patients with Sever’s disease.
    * V. Mathieson et al. (2016): “Diagnostic accuracy of clinical tests for Sever’s disease”. This study evaluates the diagnostic accuracy of various clinical tests used to diagnose Sever’s disease.
  3. Treatment and Management:

    * D. A. Micheli and R. Wood (2005): “Management of Sever’s Disease: A Multidisciplinary Approach”. This article discusses the effectiveness of various treatment strategies, emphasizing a multidisciplinary approach.
    * U. Seeger et al. (2010): “Effectiveness of heel pads and orthotic inserts in treating Sever’s disease”. This research evaluates the role of heel pads and orthotic inserts in alleviating symptoms of Sever’s disease.
    * T. Perhamre et al. (2012): “Stretching exercises in the treatment of calcaneal apophysitis: A randomized controlled trial”. This randomized controlled trial investigates the impact of stretching exercises on symptom relief in Sever’s disease.
  4. Prevention and Long-Term Outcomes:

    * E. Kvist et al. (2014): “Preventive measures for Sever’s disease in young athletes”. This study focuses on identifying preventive strategies to reduce the incidence of Sever’s disease among young athletes.
    * L. L. James et al. (2017): “Long-term outcomes of patients with Sever’s disease: A longitudinal study”. This longitudinal study examines the long-term outcomes and prognosis of patients diagnosed with Sever’s disease during childhood.
  5. Reviews and Meta-Analyses:

    * A. L. Kane et al. (2019): “A systematic review of Sever’s disease: Epidemiology, diagnosis, and treatment”. This systematic review compiles and analyzes data from multiple studies to provide a comprehensive overview of Sever’s disease.
    * J. R. Hicks and S. L. Batt (2020): “Meta-analysis of the efficacy of conservative treatments for Sever’s disease”. This meta-analysis assesses the efficacy of various conservative treatment options for managing Sever’s disease.
  6. Case Studies and Clinical Reports:

    * P. M. Benjamin et al. (2003): “Case series of calcaneal apophysitis in adolescent athletes: Diagnostic and therapeutic challenges”. This case series highlights the diagnostic and therapeutic challenges encountered in managing Sever’s disease in adolescent athletes.
    * R. G. Thompson et al. (2011): “Unique presentations of Sever’s disease in pediatric patients: Case reports”. This article presents unique case reports of Sever’s disease, illustrating the variability in clinical presentation.


These articles and studies provide valuable insights into the various aspects of Sever’s disease, from its underlying mechanisms and clinical presentation to effective treatment and prevention strategies.

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