Sever’s disease

What is Sever’s disease?

Sever’s disease (also known as Sever’s apophysitis) is a common condition affecting the heel bone in children and adolescents. Young people sometimes report pain over the heel when taking part in physical activities. The calf muscles attach to the heel bone (calcaneus) by the Achilles tendon. The bones grow more quickly than the muscles and tendons when a young person goes through a period of increased growth. The calf muscles have to catch up with the bone growth and as a result become tight. The Achilles tendon pulls repeatedly on the heel bone around the growth plate causing pain and swelling, especially if taking part in high impact activity such as running and jumping.

What are the symptoms?

• The repetitive pull of the calf muscles may cause the individual to limp or walk on their toes due to the pain.
• One or both heels can be affected.
• The heel is tender if squeezed.
• There may be local swelling where the Achilles tendon meets the bone.
• The calf muscles may be tight.

How can I make it better?

Usually the pain at the heel will settle when the individual stops growing. The following may help with the pain:

• Modifying activities often helps to settle pain and swelling. If the pain is very bad, it may be helpful to avoid high impact sports that involve running and jumping until the pain decreases. Swimming and cycling are examples of low impact activities that place less stress on the joint. These types of exercise are recommended if the heel is very painful.
• The young person can continue to play sports; however, the pain may take longer to settle down. There is no evidence to suggest that playing sports causes long term damage to the structures at the heel.
• Rest often alleviates pain and allows swelling to settle.
• Once the pain has resolved, participation in physical activity and sports should be increased in a gradual manner.
• It may be helpful to ice the heel for 10 to 15 minutes, especially after physical activity and make sure the skin is protected by wrapping the ice in a towel.
• Elevate the leg after sports to allow pain and swelling to settle.
• ‘Shock absorbing’ insoles may be of benefit in shoes or trainers. Gel heel cups can be helpful in decreasing pain.
• Supportive footwear is recommended. Any activity completed in bare feet may be painful and therefore should be avoided.

Calf stretches

The following stretches are helpful in improving muscle flexibility:

Deep Calf Stretch (Soleus )

1. Position your body against a wall as shown with foot behind
2. Point toes directly toward wall and hold heel down
3. Lean into wall as shown so that you feel a stretch
4. Hold for 30 seconds, 5 repetitions, per day

Calf Stretch (Gastrocnemius)

1. Start in a step position with both legs bent.
2. Shift your weight down and forward until you feel a stretch in your calves
3. Hold for 30 seconds, 5 repetitions, per day

How long will it take for the pain to settle?

If the individual goes through another growth spurt, the pain may affect them again. Therefore, the individual may have to temporarily cut back on high impact activities until the pain settles and should continue with the above stretches.

The pain related to Sever’s will usually settle with rest and activity modification. Once the young individual has stopped growing, the heel bone will no longer be painful.

Contacts/ Further information

Please note this leaflet is a guide only. Please consult your physiotherapist for individual recommendations.

If you have any further questions:

Please contact your physiotherapist on 01223 216633, Addenbrooke’s Hospital, Physiotherapy Outpatients

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