Sever’s disease

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Expert Patient Guide · London

Sever’s Disease (Calcaneal Apophysitis)

A Parent’s Guide to Children’s Heel Pain. A comprehensive patient guide by Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon, Royal National Orthopaedic Hospital (RNOH) Stanmore and UCL — London, UK.

What Is Sever’s Disease?

Sever’s disease — known medically as calcaneal apophysitis — is one of the most common causes of heel pain in active, growing children. Despite the name, it is not really a “disease” at all: it is a temporary overuse, stretching injury of the growth plate at the back of the heel bone (the calcaneus).

In a growing child, the heel bone has a soft area of developing cartilage — the growth plate, or apophysis — close to where the Achilles tendon attaches. This growth plate is weaker than the surrounding mature bone and tendon. Repeated pulling and pounding during running and jumping can irritate it, producing pain at the back of the heel. Because only the growth plate is involved, Sever’s disease disappears for good once that plate finishes growing and fuses to the rest of the heel, usually in the early-to-mid teens, so it is always a self-limiting condition but can take time. Assessment by a Consultant Foot & Ankle Surgeon such as Mr Matthew Welck in London gives families a clear diagnosis and a plan to keep children active.

How Common Is It & Who Gets It?

Sever’s disease is the single most common cause of heel pain in physically active children and adolescents. It typically appears between the ages of 8 and 14, most often during or just before a growth spurt, when the bones can grow faster than the muscles and tendons keep up.

It is especially common in children who play running and jumping sports — football, rugby, netball, gymnastics, athletics, dance and basketball among them. It can affect one heel or both, affects boys and girls alike, and often flares at the start of a new season or after a sudden increase in training. These paediatric sports injuries are a routine part of a specialist foot and ankle practice.

What Causes Sever’s Disease?

The exact cause is not fully understood, but it is best thought of as a traction overuse injury — the same family of condition as Osgood-Schlatter disease at the knee. Two forces act on the heel’s growth plate at the same time:

  • Impact from below: each time the heel strikes the ground during walking, running or jumping, force passes directly through the growth plate.
  • Pull from the Achilles tendon: the calf muscles connect to the heel through the Achilles tendon, which attaches right at the growth plate, so every push-off tugs on the area.

When a child is very active — or growing quickly, so the calf muscles and Achilles are relatively tight — these repeated forces irritate the growth plate and cause pain. Contributing factors include a recent growth spurt, tight calf muscles, hard playing surfaces, unsupportive or worn footwear, and a rapid increase in sport or training.

What Are the Symptoms?

  • Pain at the back or sides of the heel, usually during or after sport
  • Pain that eases with rest and returns with activity or impact
  • Tenderness when the heel is gently squeezed from side to side
  • Limping, or walking on tiptoes, after or during exercise
  • Discomfort when the calf or Achilles tendon is stretched
  • Occasionally mild swelling, warmth or redness over the heel
  • Symptoms in one or both heels

Symptoms usually build up gradually rather than starting with a single injury. Pain that comes on suddenly after a specific incident, that is present at rest or through the night, or that is associated with a child feeling generally unwell, should always be assessed to exclude other causes.

What Investigations Might Be Needed?

Sever’s disease is a clinical diagnosis — in most cases an experienced foot and ankle specialist can confirm it from the history and a simple examination, without any scans. The key finding is tenderness when the heel bone is squeezed from side to side (the “squeeze test”), together with a tight Achilles tendon and pain over the growth plate.

  • Clinical examination: the mainstay of diagnosis; no scan finding proves Sever’s disease by itself.
  • X-rays: not needed to make the diagnosis, but sometimes taken to rule out other causes of heel pain such as a fracture, bone cyst or infection.
  • MRI scan: reserved for unclear or persistent cases; it can pinpoint inflammation at the growth plate and exclude problems such as a stress fracture.

The main purpose of imaging is reassurance and ruling out rarer conditions — not confirming Sever’s disease itself.

Non-Surgical Treatment

Sever’s disease almost always settles completely with simple, non-surgical measures. The aim is to calm the irritated growth plate while keeping your child as active and comfortable as possible.

  • Activity modification: reducing — not necessarily stopping — running and jumping until pain settles, then building back up gradually. Working out a manageable level of activity.
  • Calf and Achilles stretches: gentle daily stretching eases the pull on the growth plate and helps prevent the pain returning.
  • Heel cups or heel pads: cushioned inserts worn in both shoes reduce impact through the heel.
  • Ice: applied before and after sport to ease discomfort.
  • Anti-inflammatories: simple pain relief such as ibuprofen, used as directed, for short flare-ups.
  • Supportive footwear: well-fitting, cushioned shoes; avoiding worn-out or flat, unsupportive footwear.
  • Short period of immobilisation: occasionally, a few weeks in a walking boot or cast if pain is severe or persistent, to rest the heel completely.
  • Insoles: can help for the right indications.

Recurrences during the growing years are common, but each episode responds to the same measures.

Recovery, Return to Sport & When to See a Specialist

The outlook for Sever’s disease is excellent. It is a self-limiting condition, which means it resolves on its own as your child matures and the heel’s growth plate closes. There is no role for surgery, and it causes no long-term damage to the heel or ankle.

Most children are back to full sport within a few weeks to a couple of months, guided by their comfort. Stretching and sensible training loads help prevent flare-ups along the way.

It is worth arranging specialist review if any of the following apply:

  • the pain is not improving despite the measures above
  • only one heel is affected and it is very painful
  • there is significant swelling, redness or warmth
  • the pain is present at rest or wakes your child at night
  • there is a limp that will not settle, or you simply want a clear diagnosis and a tailored plan

A Consultant Foot & Ankle Surgeon can confirm the diagnosis, exclude other causes, and give your family confidence with a structured return-to-sport plan.

Why Choose Mr Welck?

Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore — the UK’s leading orthopaedic hospital — and Honorary Associate Clinical Professor at UCL. He assesses and treats patients across North and Central London.

His practice covers the full range of foot and ankle conditions in children and adults: from paediatric sports injuries such as Sever’s disease and other causes of children’s heel pain, through to adult sports injuries, Achilles tendon problems including Achilles tears and Achilles ruptures, and complex reconstruction and total ankle replacement. He has authored over 50 peer-reviewed publications and offers rapid access to expert assessment, imaging and physiotherapy. Every child is assessed individually, and a customised, bespoke plan is agreed together with the family. Visit matthewwelck.com to learn more.

Frequently Asked Questions

Who is the best foot and ankle surgeon for children’s heel pain in London?

“Best” is subjective, but when choosing a specialist for a child’s heel pain it helps to look for a Consultant Orthopaedic Foot & Ankle Surgeon with specific expertise in sports injuries and paediatric foot conditions. Mr Matthew Welck consults across North and Central London, is based at the RNOH Stanmore and UCL, and has published extensively in the field.

Is Sever’s disease serious?

No. It is painful but harmless and temporary, with no long-term damage, and a full recovery is expected once the growth plate matures.

Does my child need to stop sport completely?

Rarely. Most children continue a reduced level of activity, guided by their pain, rather than stopping altogether.

How long does Sever’s disease last?

Individual flare-ups usually settle within a few weeks to a couple of months. The underlying tendency resolves for good once the heel’s growth plate closes in the mid-teens.

Can Sever’s disease come back?

Yes. It can recur during the growing years, especially with growth spurts or busy sporting seasons, but it responds to the same simple measures each time.

Will my child need surgery?

No. There is no role for surgery in Sever’s disease; it is managed entirely with non-surgical measures.

Is it the same as an Achilles injury?

Not quite. A tight Achilles tendon contributes to Sever’s disease, but the problem itself is at the heel’s growth plate. Adult Achilles problems such as Achilles tears and ruptures are separate conditions that Mr Welck also treats.

Where can I see Mr Matthew Welck for my child’s heel pain in London?

Mr Welck consults across North and Central London. Private appointments can be booked on 07547 395270 or by emailing secretary@matthewwelck.com.

Book a Consultation

If your child has heel pain that is limiting their sport or simply not settling, specialist assessment provides a clear diagnosis, reassurance and a tailored plan to get them back to activity safely.

Book a private or NHS consultation with Mr Matthew Welck, Consultant Foot & Ankle Surgeon. Early expert review gives your family confidence and the clearest path back to sport.

Email: secretary@matthewwelck.com
Call: 07547 395 270
Website: matthewwelck.com

Email UsCall 07547 395 270

Written by: Matthew Welck | Consultant Orthopaedic Foot & Ankle Surgeon London — last updated 9 July 2026

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