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Severs disease - adolescent heel pain

Severs disease

Condition and causes

Severs disease is a problem that can affect 8-14 year olds. It tends to come on gradually and can become extremely painful if left untreated, making walking uncomfortable and sport impossible which can be devastating for a sport loving 11 year old. 

It usually comes during or after a period high loading ie. intense sporting activity and a growth spurt. It presents as a pain in the heel. The onset can often come in the Autumn term which coincides with the return to school and sharp increase in pre-season or early season sports following a long period of down time over the Summer months. After a growth spurt, the tendons and muscles are on catch up with bone growth, this can cause tightness in the muscles of the leg putting extra pressure on the joints. Which, in the example of Severs disease is at the heel.


In most cases the pain will resolve but it will usually require some action, the most important being modifying activity so as not to make symptoms worse. It will also be beneficial to begin a daily stretching, rolling and strengthening routine, targeting the tightness in the legs and feet. Ice or dipping the foot in a bucket of cold water are usually beneficial in reducing the pain. Heel lifts in both shoes or sometimes orthotics can help in reducing the stress on the calcaneus (heel) allowing more normal movement. There is no set time for recovery or best treatment option for recovery so all options should be tried, symptoms can often resolve in 2 months.

Recovery and prevention

In terms or prevention or return to sport once symptoms have calmed down, the general rule is the number of hours per week of sport a child does should be more than their age in years i.e. a 10 year old should do no more that 10 hours a week. 

An 11-12 year old can easily achieve more than their quota through the array of sports available at school, club, academy or at county level not forgetting the extra 5 hours a week from playing football during school breaks and at lunchtime. Without much effort its quite easy to clock up 16 high intensity hours a week without a recovery day. Fast moving sports such as rugby, football and hockey can, over a period of time, overload the muscles and tendons especially of the calf complex which can lead to extra stress on the heel.