Plantar Fasciitis
Sharp heel pain that's at its worst on your first few steps out of bed, settles once you get moving, then comes back after sitting or a long day on your feet.
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Sever's Disease (Calcaneal Apophysitis)
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Registered NDIS Provider
SIRA Registered Provider
Your child's been complaining their heel hurts after footy training, or you've noticed them limping or walking on their toes after sport, and it's happening often enough that you're wondering if it's something more than growing pains. If your child is somewhere between about 8 and 14, there's a good chance you're dealing with Sever's disease, and the reassuring news first: it's extremely common, it's not actually a disease in the serious sense of the word, and it resolves completely once your child finishes growing.
What's actually causing it
During a growth spurt, a child's bones can lengthen faster than the muscles and tendons attached to them can keep up. That tightens the calf muscles and Achilles tendon, which increases the pull on the growth plate at the back of the heel bone every time your child runs or jumps. Enough repetition of that pulling force, and the growth plate becomes irritated. That's the heel pain you're seeing.
It's genuinely one of the most common causes of heel pain in active children, particularly those playing running- and jumping-heavy sports like football, basketball or ballet. Risk factors include a sudden jump in activity level, tight calf muscles, flat feet or high arches, and worn-out or poorly cushioned shoes1. It's worth knowing this sits right at the intersection of two areas we work in: genuinely a paediatric presentation since it only happens in growing bones, but also very much a sports physiotherapy one given how closely it's tied to your child's training load and sport.
How it's diagnosed
The reassuring part: this usually doesn't need an X-ray. The classic test is simple: gently squeezing the back of the heel from both sides reproduces the pain, along with discomfort when your child stands up on their toes. Imaging is really only needed if the presentation doesn't fit the usual pattern, or there's been an actual injury behind the pain rather than gradual onset1.
How we treat it
Being upfront with you: the research quality behind some of the common treatments for Sever's disease is genuinely mixed, and we'd rather tell you honestly what's better and less supported than present everything as equally proven.
- Heel cups and orthotics have the best evidence behind them: a systematic review found custom heel cups with arch support gave better short-term pain relief than heel raises alone2.
- Heel lifts showed benefit over no treatment in reducing pain during activity, though usually as part of a combined approach alongside stretching.
- Taping has some support too: one study found it gave immediate pain relief, though the evidence here is weaker (a single case series, not a large trial).
- Activity modification, not necessarily complete rest. The goal is reducing the load that's irritating the growth plate, not necessarily pulling your child out of sport altogether. We help you find that balance based on how irritable things currently are.
- Calf and Achilles stretching, along with manual therapy to address the tightness that's driving the pulling force in the first place.
Worth knowing honestly: the researchers behind that same review noted the evidence overall is still limited, and called for larger, better-quality studies2, which is exactly why an actual assessment matters more than a generic one-size-fits-all approach off a website.
Reducing the risk of flare-ups
A few practical things genuinely help while your child's heel settles down:
- Footwear matters more than people expect. Worn-out shoes, poorly cushioned shoes, and cleated boots are all recognised risk factors for aggravating Sever's disease1. A well-cushioned, properly fitted shoe genuinely reduces the load reaching that growth plate.
- Playing surfaces count too. Hard surfaces (concrete, hard courts) load the heel more than grass or a sprung floor, so where possible, more training on softer surfaces during a flare-up can help.
- Warm-ups that include calf stretching address the tightness that's driving the pulling force in the first place, rather than just managing symptoms after the fact.
When to get it checked properly
Sever's disease itself isn't dangerous, and it isn't something to panic about. But get your child properly assessed rather than assuming it's "just growing pains" if:
- The pain doesn't ease with a few days off from sport
- There's swelling, redness, or warmth around the heel, not just pain
- The pain woke them up at night, or is present even when they're not active
- It followed an actual fall or injury, rather than building up gradually
None of those necessarily mean something serious; they just mean it's worth ruling out something else before assuming it's Sever's disease.
Your first appointment
We start by listening: how it began, what makes it worse, and what it's stopping you from doing. Then we examine the area, explain what we find in plain English, and agree a plan with you. Your first visit is 40 minutes at Engadine and 30 minutes at our other clinics.
We see patients at Engadine, Mount Annan, Narellan and Appin, and at home through our mobile physiotherapy service. If you have private health cover, here's how health fund rebates work for physiotherapy.
FAQs
How long does Sever's disease last?
Most children recover fully within 2 to 3 years as the growth plate matures and fuses, and importantly, it doesn't cause any long-term problems once it resolves. That timeline can feel long if your child's mid-season right now, which is exactly why managing load properly in the meantime matters, rather than just waiting it out.
Can my child keep playing sport with Sever's disease?
Often yes, in a modified way: complete withdrawal from sport usually isn't necessary unless symptoms are severe. The aim is finding the level of activity your child's heel can currently tolerate, then adjusting as things settle, rather than an all-or-nothing choice between full training and none at all.
Does my child need an X-ray?
Usually not. Sever's disease is typically diagnosed with a simple physical examination. Imaging is generally only used if something about the presentation doesn't fit the usual picture.
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References
- Smith JB, Varacallo M. Sever Disease (Calcaneal Apophysitis). StatPearls, updated January 2024. NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK441928/
- James AM, Williams CM, Haines TP. Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever's disease): a systematic review. Journal of Foot and Ankle Research, 2013. https://pmc.ncbi.nlm.nih.gov/articles/PMC3663667/