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Renaissance Family and Cosmetic Dentistry | Severs in Folsom

          2180 E. Bidwell Street,
          Suite 100 Folsom,
          CA 95630

          Phone: 916-983-9800


Calcaneal Apophysitis (Sever's Disease)

What is calcaneal apophysitis?

The heel bone is called the calcaneus. In children, there is an area on the heel bone where the bone grows that is called the growth plate, or apophysis. Calcaneal apophysitis, also called Sever's disease, is inflammation of the calcaneal growth plate that causes pain in the heel. It is the most common cause of heel pain in children, adolescents, and teenagers.

How does it occur?

This inflamed heel growth plate is caused by overusing the foot with repetitive heel strikes. It may also occur from wearing shoes with poor heel padding or poor arch supports.

What are the symptoms?

A child will complain of heel pain. Running and jumping usually increase the symptoms.

How is it diagnosed?

The health care provider will find tenderness over the bottom part of your child's heel. In severe cases of calcaneal apophysitis, he or she may order an x-ray to be sure there is no damage to the growth plate.

How is it treated?

Your child may need to rest or do activities that do not cause heel pain. It is very important that your child wear shoes with padded heel surfaces and good arch supports. Extra heel pads may be placed in your child's shoe. Your health care provider may recommend shoe inserts, called orthotics. You can buy orthotics at a pharmacy or athletic shoe store or they can be custom-made. Your provider may also prescribe an anti-inflammatory medicine for your child.

How long will the effects last?

Pain from calcaneal apophysitis may last weeks to months and may come back if your child returns to sports or strenuous activities too soon.

When can my child return to normal activities?

Everyone recovers from an injury at a different rate. Return to activity will be determined by how soon your child's heel recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer your child has symptoms before starting treatment, the longer it will take to get better. The goal of rehabilitation is to return your child to his or her normal activities as soon as is safely possible. If your child returns too soon he or she may worsen the injury.

If the heel hurts, your child needs to rest from sports or other strenuous activities. Your child should rest for several days at a time and then go back gradually. Before returning, he or she should be able to jog painlessly, then sprint painlessly, and be able to hop on the injured foot painlessly. If at any time during this process your child develops further heel pain, he or she should rest for 3 to 4 more days until the pain is gone before trying to return again.

How calcaneal apophysitis be prevented?

Calcaneal apophysitis is best prevented by having your child wear shoes that fit properly. The heel portion of the shoe should not be too tight, and there should be good padding in the heel. You may want to put extra heel pads in your child's shoes.

Some children simply get too much physical activity (such as playing on too many teams, practicing for hours, etc). Their heel pain is a message to slow down.

STRETCH - to reduce tension along the Achilles tendon and the heel.

Technique: Warm up until you start to sweat, stretch to a gentle pull and hold without bouncing for 20 seconds.

Frequency: Do 4-8 repetitions/day, 5-7 days per week


Calf Stretch

  • Stand with your feet pointed forward
  • Keep your heels down and back leg straight.
  • Slowly bend the front leg until you feel a gentle upper calf stretch in the back leg.




Heel Stretch

  • Stand with your feet pointed forward and heels down.
  • Slowly bend the back leg until you feel a gentle lower calf or heel stretch along that leg.




STRENGTHEN - the calf muscles and Achilles tendon to prevent injury.

Frequency: Do 3 sets of 10 repetitions, 5-7 days per week.

Technique: Start by strengthening the calf muscles and the Achilles strengthening.

Calf Muscles

  1. Slowly rise up on your toes.
  2. Slowly lower your heels.

Achilles Tendon

  • Stand with your heels hanging off a step.
  • Rise on your toes, then quickly drop your heels down.
  • Stop if you feel pain during the first two sets.
  • Discontinue after 4-6 weeks.





What Is Calcaneal Apophysitis?

Calcaneal apophysitis is a painful inflammation of the heel's growth plate. It typically affects children between the ages of 8 and 14 years old, because the heel bone (calcaneus) is not fully developed until at least age 14. Until then, new bone is forming at the growth plate (physis), a weak area located at the back of the heel. When there is too much repetitive stress on the growth plate, inflammation can develop.


Calcaneal apophysitis is also called Sever's disease, although it is not a true "disease." It is the most common cause of heel pain in children, and can occur in one or both feet.

Heel pain in children differs from the most common type of heel pain experienced by adults. While heel pain in adults usually subsides after a period of walking, pediatric heel pain generally doesn't improve in this manner. In fact, walking typically makes the pain worse.


Overuse and stress on the heel bone through participation in sports is a major cause of calcaneal apophysitis. The heel's growth plate is sensitive to repeated running and pounding on hard surfaces, resulting in muscle strain and inflamed tissue. For this reason, children and adolescents involved in soccer, track, or basketball are especially vulnerable.

Other potential causes of calcaneal apophysitis include obesity, a tight Achilles tendon, and biomechanical problems such as flatfoot or a high-arched foot.


  • Symptoms of calcaneal apophysitis may include:
  • Pain in the back or bottom of the heel
  • Limping
  • Walking on toes
  • Difficulty running, jumping, or participating in usual activities or sports
  • Pain when the sides of the heel are squeezed


To diagnose the cause of the child's heel pain and rule out other more serious conditions, the foot and ankle surgeon obtains a thorough medical history and asks questions about recent activities. The surgeon will also examine the child's foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.


The surgeon may select one or more of the following options to treat calcaneal apophysitis:

  • Reduce activity. The child needs to reduce or stop any activity that causes pain.
  • Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel.
  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
  • Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue.
  • Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile.

Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.

Can Calcaneal Apophysitis Be Prevented?

The chances of a child developing heel pain can be reduced by:

Avoiding Obesity

  • Choosing well-constructed, supportive shoes that are appropriate for the child's activity
  • Avoiding or limiting wearing of cleated athletic shoes
  • Avoiding activity beyond a child's ability.
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