Calcaneal Apophysitis (Sever’s Disease)

Twelve-year-old Sarah loved playing soccer. She was on her school team and played every weekend. But one day, after a particularly long game, she started to feel pain in her heels. The pain got worse over the next few days, and she had trouble walking. She went to the doctor, who diagnosed her with a severe Disease.

Sever’s Disease is a common condition in growing children. It is caused by inflammation of the growth plate in the heel. The growth plate is a soft area of tissue at the end of a bone where new bone is formed. In children, the growth plate is still growing and is not as strong as the rest of the bone. This makes it more likely to be injured.

Sever’s Disease is usually caused by repetitive stress on the heel, such as running or jumping. The pain is usually worse after exercise and gets better with rest.

Sarah was told to rest her heels and avoid activities that put stress on them. She also wore a heel cup to help cushion her heels. After a few weeks, the pain started to go away. Sarah was able to start playing soccer again, but she was careful not to overdo it.

Sever’s Disease usually goes away on its own within a few months. However, if the pain is severe or does not go away, the doctor may recommend other treatments, such as physical therapy or anti-inflammatory medication.

What Is Calcaneal Apophysitis?

Calcaneal apophysitis is a disease of the growth plate in the heel that makes it hurt. It usually happens to kids between 8 and 14 years old because the heel bone (calcaneus) isn’t fully grown until at least 14 years old. Until then, the growth plate (physis), a weak spot at the back of the heel, is making new bone. When the growth plate is put under too much stress over and over again, inflammation can happen.

Calcaneal apophysitis is also called Sever’s disease, even though it is not a true “disease.” It is the most common reason why kids have heel pain, and it can happen in one or both feet.

Children’s heel pain is not the same as the most common type of heel pain adults have. Adults’ heel pain usually goes away after a while of walking, but kids’ heel pain usually doesn’t get better this way. Most of the time, walking makes the pain worse.


The main cause of calcaneal apophysitis is overuse and stress on the heel bone from sports. The growth plate in the heel is sensitive to running and beating on hard surfaces over and over again, which causes muscle pain and inflammation. Because of this, kids and teens who play soccer, running, or basketball are especially at risk.

Calcaneal apophysitis can also be caused by being overweight, having a tight Achilles tendon, or having a physical problem like a flat foot or a high-arched foot.

Related: Swollen Ankles: Causes, Treatments, Medical Care & Prevention


Some of the signs of calcaneal apophysitis are:

  • Back or bottom of the heel pain
  • Limping
  • Walking on toes
  • Trouble running, jumping, or taking part in regular sports or activities
  • When the sides of the heel are pinched, it hurts.


The foot and ankle surgeon asks a lot of questions about the child’s health and recent actions in order to figure out why the child’s heel hurts and rule out other, more serious problems. The foot and leg of the child will also be looked at by the doctor. Most of the time, X-rays are used to figure out what’s wrong. There may also be a need for more advanced imaging studies and lab work.


To treat calcaneal apophysitis, the doctor may choose one or more of the following:

  • Reduce activity. The child needs to cut back on or stop doing anything that hurts.
  • Support the heel. Support for the heel can come from temporary shoe inserts or custom orthotics.
  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, help lower pain and swelling.
  • Physical therapy. Stretching or other forms of physical therapy are sometimes used to help the swollen area heal.
  • Immobilization. In some serious cases of heel pain in children, a cast may be used to help the foot and ankle heal while keeping them completely still.

Because a child’s heel bone is still growing, heel pain often comes back after it has been fixed. When heel pain comes back, it could be a sign of calcaneal apophysitis or it could be a sign of

Can Calcaneal Apophysitis Be Prevented?

A child’s chances of getting heel pain can be cut by:

  • Avoiding obesity
  • Choosing shoes that fit the child’s action and are well-made and comfortable is important.
  • Trying not to wear or wearing cleated shoes as little as possible
  • Keeping kids from doing things that are too hard for them.

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