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

What is Sever's Disease?

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

It can last for up to three years while a child is still growing. Although there’s no cure, there are several things you can do to help manage the pain. The good news is that it usually resolves on its own over time.

If you’re still experiencing pain after trying the advice below, please contact us for an appointment. However, do keep in mind that ongoing pain over several years can be completely normal with this condition.

Key Points

• Affects 1 or both heels
• Most common in active children
• Manageable and self-resolving over time
• 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

Use these methods to help relieve the pain and reduce the inflammation that’s causing discomfort in the heel.

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

Recovery & Return to Activity

Try to reduce high-impact activities like running and jumping while your pain settles. How much rest you need will vary from person to person. That said, it’s still important to keep moving— choose activities that don’t make your symptoms worse, such as swimming, cycling, or rock climbing. For most people, staying active in this way isn’t harmful and can support your recovery by helping you stay strong and fit.

When the pain and inflammation have eased, you can gradually start working back towards your usual sport. Before doing so, it’s a good idea to begin with some stretching and strengthening exercises — like the ones shown below — to lower the risk of another painful flare-up.

A useful sign that you're ready to restart sport is being able to hop, skip, and jump quietly without pain. Keep in mind that recovery isn’t always a straight path—some days may feel better than others, and that’s completely normal.

Tips for a Safe and Gradual Return:

• Reintroduce one activity or training session at a time—build up slowly.
• Always warm up before and cool down after exercise.
• Continue doing your stretching and strengthening exercises regularly.
• Let your coach or instructor know that you’re returning from an injury — they can help you modify activities if needed.

It’s okay to exercise if you still have a small amount of discomfort, as long as it doesn’t worsen and settles shortly after stopping. If your pain gets worse or lasts longer after activity, take a step back and give your body more time to recover.

Sports can be resumed when pain is mild and within the green zone (1-2 level of pain out of 10).

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.

Once pain has subsided do these strengthening exercises to help prevent future flare ups.

Exercise 4: Double Leg Tip Toes on a Step

What it does: Strengthens both calf muscles and improves ankle control.
How to do it: Stand on a step with your heels hanging off the edge and hold onto a banister or sturdy surface for balance. Start in a gentle calf stretch position (heels lowered). Rise up onto the balls of your feet so you're on your tip toes, then slowly lower your heels down below the step until you feel a stretch again. To help keep your ankles aligned, place a small ball or rolled-up socks between your ankles and gently squeeze.
Hold for: 1–2 seconds at the top and bottom.
Repeat: 10–15 times, 2–3 sets, once or twice a day.

Exercise 5: Single Leg Tip Toes 

What it does: Builds strength and control in the calf muscles of each leg individually.
How to do it: Stand behind a wall or stable surface for balance. Lift one foot off the ground and rise up onto your tip toes on the standing leg. Slowly lower your heel back down to the floor. You can do this with a straight knee to target the gastrocnemius muscle or with a slightly bent knee to work the soleus muscle. As you get stronger, progress by doing this off the edge of a step (like in the previous exercise) but on one leg.
Hold for: 1–2 seconds at the top and bottom.
Repeat: Aim for a number close to twice your age per leg (e.g. 20 reps for a 10-year-old). Do 2–3 sets per leg.

Exercise 6: Lunges

What it does: Strengthens the calves, thighs, hips, and improves balance.
How to do it: Take a big step forward, then bend both knees to lower into a lunge. Your front knee should be above your ankle, and your back knee should hover just above the floor. Push through your front foot to return to standing. Use a wall or chair for balance if needed.
Try different types:
Forward lunge: Step forward then return.
Walking lunge: Keep stepping forward, alternating legs.
Backward lunge: Step backward then return.
Progression: To make it harder, hold the lunge position at the bottom, then rise onto the tip toes of your front foot before slowly lowering your heel again.
Hold for: 2–3 seconds at the bottom (longer if holding or adding heel raise).
Repeat: 8–12 reps per leg, 2–3 sets.

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/