Sever’s disease (medically known as calcaneal apophysitis) is a common source of heel pain that frequently affects active, growing children. This condition occurs during a child’s rapid growth phase, leading to discomfort that may interfere with their favorite activities. Many parents and young athletes wonder if they must stop playing sports entirely when symptoms arise. The encouraging news is that, with proper management and specific modifications, continued sports participation is often possible. This temporary condition requires a thoughtful, pain-guided approach to keep children safely in the game.
Understanding Sever’s Disease
Sever’s disease is an overuse injury involving the growth plate at the back of the heel bone, called the calcaneal apophysis. This growth plate is a layer of cartilage that is softer and more vulnerable to stress than the surrounding mature bone tissue. The pain results from the repetitive pulling force exerted by the Achilles tendon, which connects the calf muscles to this susceptible growth area.
The condition typically affects children between the ages of 8 and 14 years, coinciding with their adolescent growth spurts. During these periods, the bones often lengthen faster than the surrounding muscles and tendons can stretch, resulting in increased tension on the growth plate. High-impact activities that involve frequent running, jumping, or sudden stopping—such as soccer, basketball, and gymnastics—are common triggers for this irritation.
Determining Activity Level During a Flare-Up
The decision to play during a flare-up must be guided by the child’s current level of pain, as continued activity should not significantly worsen the symptoms. A practical “Pain Scale Rule” can help parents and coaches make an immediate assessment. If the child experiences pain during an activity but the discomfort subsides quickly after a period of rest, it usually indicates that activity modification is needed, but complete rest may not be mandatory.
However, if the pain begins to limit the child’s performance, causes them to visibly limp, or persists into the next morning, it is a signal that the heel requires immediate reduction in activity. Playing through sharp, worsening pain can prolong the condition. Temporarily substituting high-impact training with non-weight-bearing activities allows the inflammation to calm down while maintaining cardiovascular fitness.
Strategies for Safe Sports Participation
Managing Sever’s disease while staying active centers on reducing the mechanical tension placed on the painful heel growth plate. Footwear modifications are often the most immediate and effective change, as they directly cushion and support the heel. Shoes used for daily wear and sports should feature well-cushioned soles and robust arch support.
Inserting specialized heel cups or heel lifts into the child’s athletic shoes, including cleats, is highly recommended. These inserts elevate the heel slightly, which effectively shortens the distance between the calf muscle and the heel bone, reducing the pulling force of the tight Achilles tendon on the growth plate. This measure helps absorb impact forces during running and jumping, minimizing direct pressure on the inflamed area.
Activity modification is another strategy that allows for continued participation while managing symptoms. This involves reducing the volume and frequency of high-impact training sessions, rather than stopping all activity. Cross-training with low-impact options such as swimming, cycling, or rowing helps maintain conditioning without aggravating the heel. Open communication with coaches ensures the child can take frequent rest breaks during practice and games, especially when pain increases.
Specific stretching and pain management protocols should be integrated into the child’s daily routine. Gentle stretching of the calf muscles, specifically the gastrocnemius and soleus, is important for lengthening the muscle-tendon unit and decreasing strain on the heel. These stretches should be performed multiple times a day, holding the stretch for 30 seconds per repetition. Post-activity care must include icing the affected heel for 15 to 20 minutes to reduce inflammation and pain.
When Does the Condition Resolve?
Sever’s disease is considered a self-limiting condition, meaning that it will resolve naturally over time without causing any long-term damage. The duration of symptoms varies significantly among children, but the condition is temporary and directly linked to skeletal maturity. Once the child’s growth spurt ends, the calcaneal growth plate gradually hardens and fuses into solid bone.
This fusion process, which typically occurs between the ages of 14 and 16, eliminates the vulnerable cartilage layer that was the source of the pain. After the growth plate closes, the symptoms of Sever’s disease will not return, and the child can resume full activity without restriction. While the pain may last anywhere from a few months to a couple of years, there are no lasting consequences once the heel is fully matured.