Diagnosing Sever's Disease

How to Determine if Your Child's Heel Pain is Being Caused by Sever's Disease

There are a few causes of heel pain in children, but it is estimated that 90% of the time it can be attributed to Sever’s Disease.  Sever’s disease affects children from ages 7 to 15. 
The most obvious symptom of Sever’s is pain or tenderness on one or both heels. It is more apparent in children that play sports, particularily “ground and pound” activities like soccer or gymnastics (and football, basketball, dance, etc…)
Child playing soccer with Sever's disease

Boys may see their growth spurts between the ages of ten and fifteen, while girls may see it between seven and thirteen.

How to Identify Sever's Disease in Your Child

Sever’s disease is relatively easy to diagnose. By simply grasping the child’s heel and applying pressure on both sides, this will place pressure on the growth plate and in turn immediately result in discomfort for the child.

(***For an official diagnosis we recommend being evaluated by a pediatric podiatrist, or other children’s foot specialist.)

A podiatrist will diagnose Sever’s disease in office by taking your child’s medical history, discussing their usual activities, and paying special attention to any sports and how often they are played. Then they will examine the child’s foot, lightly squeezing both sides of the heel to check for pain. The doctor will also check to see if they feel any pain standing on their tip-toes and flat on their feet. Lastly, x-rays or other diagnostic imagery may be ordered to rule out any acute injuries, such as fractures.

What Causes Sever's Disease?

Some causes of Sever’s disease include:

  • A child’s regular growth cycle
  • Sports with a lot of “ground and pound” like running, soccer or gymnastics
  • Obesity or being overweight, which may put extra pressure on the growth plate
  • A pronated foot, or a foot with an ankle that rolls while walking. Pronation can cause tightness and twisting of the Achilles tendon, increasing the pull on the growth plate
  • Short leg syndrome, which is when one leg is shorter than the other, forcing the shorter leg to bend down to reach the ground
  • High or flat arches
  • A tight Achilles tendon

The child’s feet repeatedly striking hard surfaces can cause and or aggravate Sever’s Disease. Children who participate in activities such as basketball, soccer, and track are more likely to experience the type of inflammation that leads to Sever’s Disease. The above causes may exacerbate the stress added to your child’s feet during high-impact activities.

What Are the Symptoms of Sever's Disease?

The most common symptom of Sever’s disease is pain or tenderness in one or both of the heels. While this pain usually forms in the back of the heel, it is also possible for it to go down the sides and bottom of the heel, around the arch of the foot. You may also notice your child is unable to participate in activities or sports to their usual ability, or even at all.

Other symptoms and signs of Sever’s disease include:

  • Abnormal gait, tip toe walking (to avoid pressure on the heel) or difficulty walking
  • Discomfort or pain when the heel is squeezed on both sides
  • Redness or swelling of the heel
  • Stiff or uncomfortable feet when walking
Heel pain from severs disease

The Difference Between Acute and Chronic Sever's Disease

Sever’s disease may be either acute or chronic. Acute Sever’s disease is somewhat easier to treat, with treatment options typically taking much less time than those required for chronic Sever’s disease.

Chronic Sever’s disease is an ongoing condition that requires more long-term care. Both should be addressed as soon as possible, but which type of Sever’s disease your child has determines the best path forward for treatment.

How is Sever's Disease Treated?

Acute Sever's

Though some treatment methods for acute and chronic Sever’s disease overlap, the two require different treatment plans.

If your child has acute Sever’s disease, the primary treatment is rest, which relieves the pressure causing them pain. Be sure to ask your child’s pediatrician how long the rest period should last. Additional treatments for acute Sever’s disease include:

  • Changing footwear
  • Over-the-counter anti-inflammatory medications such as ibuprofen
  • Over-the-counter gel heel inserts
  • Reduction or suspension of sports and similar activities

Chronic Sever's

Chronic Sever’s disease requires a more aggressive treatment.. The podiatrist works with your child to alleviate the pressure on their growth plate by changing the way their foot hits the ground. This process involves creating a ridged deep heel cup orthotic device customized to your child’s foot, which distributes the pressure to stop the pain. The device goes in all of your child’s footwear, including athletic shoes, allowing them to remain active.

A nighttime pediatric orthotic boot that will passively stretch the child’s heel and tendons during their sleep is als highly recommended. Used in conjunction with custom shoe orthotics:

  1. Increases effectiveness of the treatment
  2. Decreases the time it takes for the Sever’s to completely resolve
  3. Decreases the chances of Sever’s disease ever returning
  4. And allows the child to start their day without heel pain or pain considerably lessened

Some rare cases may require a boot or cast to immobilize the foot day and night for two to three weeks.


The most effective chronic Sever’s treatment are custom orthotics worn in the child’s shoes or cleats like the Mikki Device™, and a pediatric nighttime boot. Custom Sever’s orthotics evenly distribute the child’s weight and provide consistent foot and heel support throughout the day, and the nighttime boot supports and passively stretches the heel and tendons at night. 

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Adult & Children's Heel Pain Are Not The Same

Whether your child has acute or chronic Sever’s Disease, their podiatrist will likely recommend light stretches to strengthen the surrounding muscles and tendons. Your child should also elevate their leg and apply ice (not directly to the skin) for 20 minutes up to three times a day, even on days with no pain.

While acetaminophen and ibuprofen are acceptable for pain and swelling, avoid giving your child aspirin. There are over-the-counter orthotics, with some being better than others, but custom orthotics always produce the best results. In the case of chronic Sever’s Disease, custom orthotics are absolutely necessary.

It is important to remember that adults and children suffer from heel pain in different ways. Pediatric heel pain does NOT get better with continued walking and extended periods of standing the way plantar fasciitis does; both will aggravate the condition and put additional pressure on the heels.

Can You Prevent Sever's Disease?

The best way to protect your child from developing Sever’s disease is to ensure they wear supportive, quality shoes. Though this is especially true for children who play sports. All foot health starts with appropriately sized, well-fitting shoes. Many people talk about “breaking in” or “growing into” shoes, but the truth is, shoes should feel comfortable right away no matter your age. Talk to your child’s podiatrist about properly sizing their feet, and be sure to have them try on shoes in a physical store before ordering online.

If your child plays sports, make sure they stretch after activity. Always apply ice, though not directly to the skin, and elevate the foot if they experience heel pain.


Sever’s disease can cause extreme pain, so don’t ignore it. Children can eventually outgrow Acute Sever’s, but Chronic Sever’s left untreated will continue. If you notice your child limping or walking abnormally, schedule an appointment with your pediatrician or pediatric podiatrist to determine whether your child has Acute or Chronic Sever’s disease.

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