On the bones of children and adolescents, there is a special area where the bone is growing called the growth plate. Growth plates are areas of cartilage located near the ends of bones.

When a child is fully grown, the growth plates close and are replaced by solid bone. Until this happens, the growth plates are weaker than the nearby tendons and ligaments and are vulnerable to trauma.

An X-ray of an adolescent foot shows the open growth plate of the calcaneus, or heel. The X-ray appearance of Sever's disease looks similar to those without symptoms. Your child's doctor may still order X-rays to rule out other causes of pain, like a fracture.

Reproduced from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Sever's disease affects the part of the growth plate at the back of the heel. This growth area serves as the attachment point for the Achilles tendon. The Achilles tendon is the strong band of tissue that connects the calf muscles at the back of the leg to the heel bone.

Repetitive stress from running, jumping, and other high-impact activities can cause pain and inflammation in this growth area of the heel. The Achilles tendon pulling at its attachment point can sometimes further irritate the area.

Illustration shows the area where the Achilles tendon attaches (inserts) into the heel bone.

Painful symptoms are often brought on by running, jumping, and other sports-related activities. In some cases, both heels have symptoms, although one heel may be worse than the other. Symptoms may include:

• Heel pain and tenderness underneath the heel
• Mild swelling at the heel

The red shading shows the typical areas of pain from Sever's disease.  

During the appointment, your child's doctor will:

• Discuss your child's symptoms and general health.
• Conduct a thorough examination of the foot and ankle to determine the cause of the pain. This will include applying pressure to the heel bone on both the bottom of the bone and along the sides. These areas are tender or painful for a child with Sever's disease.
• Possibly ask your child to walk, run, jump, or walk on their heels to see if those movements cause pain.

Treatment for Sever's disease focuses on reducing pain and swelling. This often means limiting exercise activity. In some cases, rest from activity is required for several months, followed by a strength conditioning program. However, if your child does not have a lot of pain or a limp, it may be safe for them to continue sports participation.

Your child's doctor may recommend additional treatment, including:

• Heel pads. Heel cushions inserted in sports shoes can help absorb impact and relieve stress on the heel and ankle.
• Wearing shoes with a slightly elevated heel. Elevating the heel may relieve some of the pressure on the growth plate.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Drugs like ibuprofen and naproxen can help reduce pain and swelling.
• Exercises.  Once the pain is beter, your child can start exercises to stretch the calf muscle and strengthen the leg muscles.
• Walker boot. Sometimes, a "walker boot" might be required to immobilize the foot while it heals.

Heel cord stretch. You should feel this stretch in your calf and into your heel.

It is not unusual for Sever's disease to recur (come back). This can happen when a child once again increases sports activities. Wearing shoes that provide good support to the foot and heel helps.

Sever's disease will not return once a child is fully grown and the growth plate in the heel has matured into solid bone.