Calcaneal Apophysitis
The most common cause of heel pain in active children
Sever's disease is inflammation of the growth plate at the back of the heel (calcaneal apophysis). It affects children aged 8–14, especially those who play sports on hard surfaces. Despite the name, it is not a true disease — it is a painful but self-limiting condition that resolves once the growth plate fuses. With proper management, many children can continue sports during treatment. Heel pain can also have other causes, such as a calcaneal stress fracture, osteomyelitis, or a bone tumour, so the cause should be confirmed first.
The calcaneus (heel bone) grows quickly, but the Achilles tendon cannot keep pace
The tight Achilles pulls on the heel's growth plate (apophysis) with every step
Running and jumping on hard surfaces multiply the tensile stress on the growth plate
Micro-damage accumulates, leading to pain, tenderness, and swelling at the heel
Once the apophysis fuses to the calcaneus (usually by around age 15), symptoms typically settle
Symptoms usually settle over a few weeks to a few months, though pain can flare again when sport resumes and the course is sometimes prolonged. Once the growth plate fuses, usually by around age 15, symptoms typically stop recurring. Most children can continue modified sports participation during treatment. The condition does not cause permanent damage to the heel bone.
Clinical note: The diagnosis is primarily clinical — X-rays are usually not necessary but may be taken to rule out fracture. The classic finding is pain on bilateral heel squeeze (squeeze test). Fragmentation of the apophysis seen on X-ray is a normal variant and not diagnostic of Sever's disease.