Heel Pain in Children (Sever’s Disease) Heals Quickly with Physical Therapy

What is Sever’s Disease?

Sever’s Disease (calcaneal apophysitis) is one of the most common forms of heel pain in children.   Sever’s Disease is located where the lower calf muscles and Achilles tendon attach onto the heel bone,(calcaneus).  It mostly occurs during a child's growth spurt, when the muscles, tendons, and bones develop or lengthen at different rates.  For example, the bone may elongate, but the muscle attached to the bone stays the same length, is too short and this creates tension. Your child either complains of point tenderness at the lower calf/heel area, has more pain in the morning vs night, may walk differently to compensate and has increased pain with running and jumping.  If your child is very active, or plays sports, more stress is placed on the area, resulting in more heel pain.

Why does it occur?

While Sever’s Disease can occur in any child, there may be some factors which increase the chances for developing this condition. Kids who have pronated feet are more likely to experience pain from Sever’s Disease because of the increased angle / tension placed on the Achilles tendon.       A child who has a with a higher than usual arch, or those with a lower than usual arch, may also be more prone to abnormal forces at the Achilles tendon. A child who is overweight may also be more likely to experience pain at the calcaneus secondary to increased forces & poor foot positioning with weight bearing activity.

PHYSICAL THERAPY – Manual Techniques are Key

Because Sever’s Disease stems musculoskeletal inefficiencies, licensed physical therapists who perform targeted manual therapy is the best treatment option for children, achieving results in a short amount of time.

Current research supports manual techniques performed by physical therapists, to reduce pain from Sever’s Disease and improve function of various muscles.   When the larger calf muscles and smaller, deeper, stabilizer ankle/foot muscles become tight, they can change the mechanics of the ankle joint.  Manual therapy includes both joint and muscle release techniques.  Gentle ankle/foot joint mobilization allows improved efficiency of overall biomechanics of the ankle and foot, ultimately reducing unnecessary strain & pain.  Soft tissue mobilization includes deep tissue massage, trigger point release, positional release, & myofascial release to allow the calf, ankle and foot muscles to lengthen & functional optimally.

PHYSICAL THERAPY – Exercise to improve function

Physical therapists have the expertise following their seven years of medical studies of the human body,  plus post graduate courses in sports science,  to design and teach a stretching and proprioception training program.  Specific stretches are prescribed to do at home to release and re educate the restricted calf and foot muscles  We thoroughly analyze your child’s walking, running and balance strategies and teach specific strength and balance exercises to maximize his /her movement patterns so they can function in life and sport pain free.

Most children have decreased heel pain, decreased feeling of pressure and improved ability to move well during sport following 6-10 sessions of physical therapy while following our home exercise program.


Grady, M.D. , Matthew F., and Arlene Goodman, M.D. "Common Lower Extremity Injuries in the Skeletally Immature Athlete." Current Problems in Pediatric and Adolescent Health Care. 40.7 (2010): 170-183. Web. 2 Jan. 2013.

Kravitz, et al. "The Diagnosis and Treatment of Heel Pain: A Clinical Practice Guideline–Revision 2010 ." Journal of Foot and Ankle Surgery. 49.3 (2010): S1-S19. Web. 2 Jan. 2013.

Sawyer, M.D., Gregory A., Craig R. Lareau, M.D., and Jon A. Mukand, PhD. "Diagnosis and Management of Heel and." Medicine & Health. 95.4 (2012): 125-127. Web. 2 Jan. 2013.

2 Responses

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