Sever’s Disease

What is Sever’s disease?


Sever’s disease is a common cause of heel pain, particularly in the young and physically active. It usually develops just before puberty. Boys are slightly more prone to this condition than girls. Physiotherapy can help manage the symptoms of Sever’s disease so that the young person can continue to engage in physical activity.


Another name for Sever’s disease is calcaneal apophysitis. ‘Calcaneus’ is your heel bone, ‘apophysis’ is where the tendon joins the heel and ‘itis’ means inflammation. ‘Sever’ is the person who first identified this condition.

The structure of the heel


A big tendon called the ‘Achilles’ tendon joins the calf muscle at the back of the leg to the heel. Sever’s disease is thought to occur because of a mismatch in growth of the calf bones to the calf muscle and Achilles tendon. It is thought that the bones grow faster than the muscles, so the muscles and the Achilles tendon that attach the muscle to the heel get tight. At the same time, the heel bone is soft and weak around its growth centre. The tight calf muscle and Achilles tendon cause a traction injury on the soft heel. The traction causes tiny bits of bone to pull away, causing inflammation.


Sever’s disease most commonly affects boys aged ten to 12 years and girls aged nine to 11 years, when growth spurts are beginning.


Sever’s disease heals itself with time. This is known as ‘self limiting’. There is no evidence to suggest that Sever’s disease causes any long-term problems or complications.

Sever’s disease symptoms & pain


There are a few signs and symptoms that indicate Sever’s disease, which may affect one or both heels. These include:

  • Pain at the heel or around the Achilles tendon
  • Heel pain during physical exercise, especially activities that require running or jumping
  • Worsening of pain after exercise
  • A tender swelling or bulge on the heel that is sore to touch
  • Calf muscle stiffness first thing in the morning.
  • Limping
  • A tendency to tiptoe.

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