Calcaneal Apophysitis is also called Severs Disease and is a common condition of the growth plate at the back of the heel bone in kids.The pain is present at the back and sides of the heel, usually worse after sports activity. As it is a problem with the growth plate, it will come right on its own as the child’s growth in the heel bone stops. It is most commonly treated with a cushioned heel inserts and is a self limiting problem that eventually comes right by itself.
This video from PodChatLive was a good discussion on Calcaneal Apophysitis with an expert in the topic for those who want a deep dive into the topic:
For other videos on Severs disease, see PodiatryTube.
Calcaneal apophysitis, more commonly known as Sever’s disease, is an overuse injury that primarily affects children and adolescents. It occurs at the growth plate (apophysis) in the heel bone (calcaneus), where the Achilles tendon attaches. During periods of rapid growth, especially between the ages of 8 and 15, the bones often grow faster than the muscles and tendons, creating tension at this attachment point. The repetitive stress from activities such as running, jumping, or playing sports can irritate and inflame the growth plate, leading to heel pain. Importantly, despite the name “disease,” it is not an infection or degenerative condition—it is a self-limiting growth-related issue.
The hallmark symptom of calcaneal apophysitis is pain at the back or underside of the heel, which worsens with physical activity and improves with rest. Children may limp, walk on their toes to avoid putting pressure on the heel, or complain of soreness after sports practice. The pain is usually bilateral (in both heels) but can occur in just one heel. Swelling and tenderness may also be present around the heel bone. Unlike plantar fasciitis, which is more common in adults and involves pain under the arch or heel, calcaneal apophysitis is specifically tied to skeletal immaturity and growth plate stress.
Diagnosis is generally clinical, based on history and physical examination. Imaging like X-rays is not always necessary unless there is concern about other causes of heel pain, such as fractures, infections, or tumors. Doctors often perform a “squeeze test,” applying pressure to the heel from both sides, which typically reproduces the pain. Since it’s strongly linked to growth spurts and high-impact activities, understanding the child’s sports involvement and developmental stage is essential. Differential diagnoses may include Achilles tendinitis, plantar fasciitis, or bursitis, but these are less common in this age group.
Treatment for calcaneal apophysitis is usually conservative and focuses on relieving symptoms while allowing the growth plate to heal. Rest and activity modification are crucial, particularly avoiding repetitive jumping and running until symptoms improve. Ice, stretching exercises for the calf and Achilles tendon, and heel cups or cushioned shoe inserts can help reduce stress on the heel. Over-the-counter anti-inflammatory medications may also ease discomfort. Most children outgrow the condition as the growth plate closes, meaning symptoms rarely persist into adulthood. The key is to balance physical activity with adequate rest, ensuring young athletes can continue participating in sports witho
Most Useful Resources on this topic:
Calcaneal Apophysitis (Foot Health Forum)
Calcaneal Apohysitis or Stress fracture (Podiatry Arena)
Calcaneal Apophysitis (Podiatry Arena)
Calcaneal Apophysitis (PodiaPaedia)
Heel Pain in Children (Severs Disease; Calcaneal apophysitis) (ePodiatry)
Severs Disease or Calcaneal Apophysitis? (Croydon Total FootCare)