How is Sever's disease different in children?

During growth, the heel bone and surrounding tendons do not always lengthen at the same pace. Running, jumping and sport can repeatedly load the heel’s growth area. A child may report pain at the back or underside of the heel, tenderness when it is squeezed from the sides, or a limp after activity. The condition affects a developing heel; it is different from an adult tendon problem or a sudden fracture.

A clinician checks the heel, ankle, calf flexibility, walking pattern and activity history. Imaging is not always needed, but it may be considered when symptoms are unusual or another injury needs to be excluded.

Reduce or pause activities that reproduce heel pain, then use lower-impact movement if comfortable. Ice wrapped in cloth after activity, supportive shoes and a heel cup or insert may reduce loading. Gentle calf stretching and a gradual strengthening plan can help when taught by a clinician. A child should return to running and jumping in stages, guided by symptoms and normal walking.

Arrange an assessment when heel pain keeps returning, causes limping, limits sport or does not settle with reduced loading. Seek prompt care after a fall or direct blow, or for marked swelling, bruising, fever, redness, night pain, inability to bear weight or pain in a child who appears unwell.

Ask whether the pain fits Sever's disease, what activity changes are needed, and whether footwear, a heel insert or physiotherapy could help. Discuss a safe return-to-sport plan and which symptoms would suggest a fracture, infection or another cause.