Sever’s Disease in Kids – Why kids have heel pain AFTER training

Are your kids complaining of heel pain after sport or training? Sometimes this can happen with or without pain during training or sport. This is likely, although not always, to be what’s known as Sever’s Disease.

The more technical term for this is calcaneal apophysitis, which is an inflammation of the growth plate in the heel of growing children.

Sever’s Disease tends to turn up in very active adolescents when there is lots of growing combined with repetitive stress to the heel. This is because the growth plate is very active during this phase of a child’s life. Combine this with the extra training, possibly some muscle imbalances and poor lower limb alignment, and you have a problem. It usually resolves when the bone has stopped growing or the child stops exercising.

What are the signs and symptoms?

Often I see children who are experiencing heel pain during sport but it’s not uncommon for it to hurt most after the cool down phase. So, you may hear complaining of pain from your kids after the drive home and they go to get out of the car limping. Or sometimes it can show up as limping when they get out of bed the next day.

The heel itself will usually look completely normal. Heel pain is usually the most prominent symptom and I usually diagnose it with the squeeze test. This means that the child will experience pain when I squeeze the inside and outside of their heel. X-rays and ultrasounds are usually not warranted, unless the situation is quite severe or we need to exclude other causes of the pain.

Why does Sever’s Disease happen?

Possible causes include:

  • Fast rate of growth
  • Too much training
  • A sudden change in training volume
  • Changes in training floor surfaces
  • Poor quality shoes
  • Poor lower limb alignment and muscle imbalances.


As a physiotherapist that sees a lot of kids with Sever’s Disease I like to focus on reducing pain, minimising damage and preventing it re-occurring. I also work hard with the patient and family to try to keep up their physical activity levels but provide guidance if training needs to be tapered for at least a little while. Often I find taping a useful tool to help with taking the stress off the heel until symptoms settle down.

Finding the causes of the problem is super important. Once that is done a treatment and exercise plan is devised to get the child pain free and back to sport.

By Rosemary Marchese, Physiotherapist

Rosemary is Practice Principal at Max Sports Physiotherapy and a physiotherapist with an additional 20+ years’ experience in fitness consulting and training. In 2017 she became a Schroth-Barcelona Institute C1 Certified Physiotherapist and is recognised in the 3-D treatment of Scoliosis according to principles of C.L.Schroth. She is dedicated to combining this knowledge and training with her <repertoire of skills to provide the best possible treatment for her patients.

Rosemary is passionate about healthy lifestyles and communicates well with sporty children who are experiencing injury, particularly the elite level athletes. Her strengths include being able to assess the situation to determine a successful return to sport as quickly as possible without jeopardising the child’s health and fitness. Often the athletes are prescribed whole body, sport-specific training (usually in collaboration with coaches and doctors) to ensure that fitness is not lost while recovery is taking place. This principle also applies to the <adults she treats with return to sport, work or lifestyle activities at the forefront of her mind.

Rosemary has established a Children’s Stretch and Strength Class that runs weekly to help local children increase strength and flexibility <specific to their sport. Seeing the need for improved nutrition in these athletes she combined with a local Dietitian to commence school holiday Cook, Eat, Move classes.

In her spare time she loves spending time with her husband and three children, exercising, and is a volunteer for Cancer Council NSW as a <Member of Parliament Liaison for Pittwater, advocating the campaigns of the Cancer Council to the government.


Author: Laurice Klaire

Weekly Newsletter Sign Up