Comprehensive information and exercises to help your child manage heel pain during growth spurts.

What is Sever's Disease?

Sever's disease is heel pain that occurs in growing children, typically between ages 9-15. Despite its name, it's not actually a "disease" but a common growth-related condition that affects the growth plate in the heel bone.

Key Points

• Affects 1 or both heels
• Most common in active children
• Completely treatable and temporary
• Resolves naturally when growth stops

Causes & Symptoms 

What Causes Sever's Disease: During growth spurts, bones grow faster than muscles and tendons. This causes the Achilles tendon to become tight and pull on the heel bone's growth plate, creating pain and inflammation.

Common Symptoms Checklist:

• Heel pain during or after activity
• Limping or walking on toes
• Pain that improves with rest
• Possible swelling at back of heel
• Difficulty participating in sports
• The heel is tender if squeezed  

Risk Factors:

• Active in sports involving running/jumping
• Ages 9-15 (peak growth years)
• Rapid growth spurts
• Tight calf muscles
• Poor footwear

Treatment & Management

Immediate Care (R.I.C.E. Protocol):

Rest:

• Reduce sports activity until pain subsides
• Avoid high-impact activities (running, jumping)
• Consider low-impact alternatives: swimming, cycling, yoga

Ice:

• Apply for 10-15 minutes after activity
• Always wrap ice pack in towel
• Use 2-3 times daily during flare-ups

Compression & Elevation:

• Elevate leg when swollen
• Supportive shoes with good heel cushioning
• Consider heel pads or orthotic inserts

Additional Treatment Options:

• Over-the-counter pain relief (consult GP first)
• Physical therapy if symptoms persist
• Proper footwear assessment
• Activity modification rather than complete rest

Exercise Programme

Doing these stretches regularly can help reduce heel pain by easing tightness in your calf muscles. Try to do each exercise 3 times a day, especially after school or sports.

Exercise 1: Standing Calf Stretch (Gastrocnemius)

What it does: Stretches the upper calf muscle.
How to do it: Stand facing a wall, door, or sturdy surface with your hands resting on it for support. Step one foot forward and bend that front knee. Keep your back leg straight and your back heel flat on the floor. Lean your body gently towards the wall until you feel a stretch in the upper part of your back leg.
Hold for: 30 seconds, then relax.
Repeat: 2 times on each leg, 3 times a day.

 

Exercise 2: Bent-Knee Calf Stretch (Soleus)

What it does: Stretches the lower calf muscle and deeper tissues.
How to do it: Start in the same position as Exercise 1, facing the wall with one foot stepped forward. This time, slightly bend the back knee while still keeping the back heel on the floor. You should feel the stretch lower down in your calf, closer to your ankle.
Hold for: 30 seconds, then relax.
Repeat: 2 times on each leg, 3 times a day.

 

Exercise 3: Step Stretch (Heel Drop)

What it does: Stretches the entire calf muscle group
How to do it: Stand with the front of your feet on a step or bottom stair, and hold on to a rail or wall for balance. Let your heels slowly lower below the step level, so they hang gently off the edge. You should feel a stretch in the backs of your legs.
Hold for: 30 seconds, then slowly return to the starting position.
Repeat: 2 times, 3 times a day.

Recovery & Return to Activity

Timeline Expectations:

• Acute Phase: 2-4 weeks with proper care
• Recovery Phase: 1-3 months for complete resolution
• Return to Sport: Gradual progression once pain-free

Return-to-Activity Protocol:

Week 1-2: Pain-free daily activities
Week 3-4: Light jogging/walking
Week 5-6: Sport-specific movements
Week 7+: Full return with ongoing prevention

Sports can be resumed when pain is mild and within the green zone.

Warning Signs to Watch For:

• Persistent pain despite rest
• Severe swelling
• Inability to bear weight
• Pain affecting daily activities
• Symptoms lasting >3 months

Prevention Strategies

Long-term Management:

• Continue daily stretching routine
• Proper warm-up before activities
• Appropriate footwear for each sport
• Gradual training progression
• Regular strength training for calves

Footwear Guidelines:

• Supportive shoes with good heel cushioning
• Replace worn athletic shoes regularly
• Avoid walking barefoot for long periods – wear supportive shoes, even indoors
• Consider custom orthotics if recommended

Resources

Physiopedia: https://www.physio-pedia.com/Sever%27s_Disease
CSP: https://apcp.csp.org.uk/documents/parent-leaflet-calcaneal-apophysitis-severs
NHS: https://www.cuh.nhs.uk/patient-information/severs-disease/