What it is
Sever’s disease is a painful irritation of the heel growth plate where the Achilles tendon attaches, caused by repetitive stress from activities like running and jumping. This condition is common in active, growing children and teens, typically between the ages of 8 and 15, because their growth plates have not yet completely fused to the bulk of the bone. Growth plates enable bone growth to occur, but they are also sites of weakness in the bone, which are more prone to injury.
Although the exact reason young athletes have pain is often unknown, it typically occurs during growth spurts, suggesting that changes to bone growth and the capacity of muscle and tendons to maintain ‘pain-free’ traction are compromised. Repetitive contraction and tightening of the calf, achilles tendon and plantar fascia during high-load activities, such as planting, cutting, jumping, and running sports like soccer, netball, and football, increase tension of these structures, causing an inflammatory reaction at the site of the active growth plate in the heel, which is seen in this condition.
The heel pain symptoms ease with rest and return with increased load if the plan remains unchanged. Symptoms include heel pain, swelling, limping, and pain when squeezing the sides of the heel.
What happens when it occurs
Traction from the calf and achilles increases stress on the heel growth plate. Load control and strength in safe ranges reduce traction until maturity is achieved.
Common causes and risk factors
- Rapid height gain and tight calves
- High volumes of running and jumping at school and sports
- Hard surfaces, such as synthetic pitches with minimal cushioning
- Footwear selection
- Previous heel pain in the same season
Who is most affected
Active children in late primary to early secondary school years. Boys present more often than girls.
Typical symptoms
- Pain in the back or underside of the heel during and after activity
- Morning stiffness that settles with movement
- Soreness when squeezing the sides of the heel
- Stiffness post-activity after rest or prolonged period of sitting
When to seek care
If heel pain limits sport for more than two weeks, or if walking becomes painful.
How we diagnose
History and examination, including the squeeze test of the heel, calf length, and hop testing. Imaging is usually not required.
Management
- Reduce running and jumping volumes while strength is rebuilt
- Calf and achilles isometrics, then heavy slow raises within comfort
- Heel cups or supportive trainers for impact comfort
- Graded return to running and sport
Rehabilitation milestones
Phase 1 weeks 0 to 2: pain control, isometrics, gentle calf mobility, flat walking.
Phase 2 weeks 2 to 6: heavy slow calf raises, skipping drills at low volume.
Phase 3 weeks 6 to 10: return to run, acceleration and deceleration practice.
Phase 4 weeks 10 to 14: full training loads with jump progressions.
Readiness to progress
- Single leg calf raises 20 to 25 without pain
- Hop tests without heel pain
- Training session completed without a next day flare
Prevention
- Maintain calf strength and ankle mobility during growth spurts
- Build weekly running and jumping in small steps
- Use suitable footwear for the surface and sport
Australia snapshot
- Very common in school and club sport seasons
- Often affects both heels
- Boys present more often than girls in Australian clinics
Latest insights
Control traction loads first, then rebuild strength and running volume.
Most cases improve with a clear plan and do not need scans.
