Sever’s Disease Symptoms, Causes, Physical therapy Treatment

Read about Sever’s Disease  symptoms, Causes, Physical therapy and Exercises.

Sever’s disease also called calcaneal apophysitis, is a painful bone disorder that results from inflammation (of the growth plate in the heel. A growth plate, also known as epiphyseal plate, is an area at the end of a developing bone where cartilage cells change over time into bone cells. As this occurs, the growth plates expand and unite, which is how bones grow.

During a growth spurt, a child heel bone grows faster than the muscles, tendons, and ligaments in their leg. In fact, the heel is one of the child’s first body parts to reach full adult size. When the muscles and tendons can’t grow fast enough to keep up, they are stretched too tight.

If the child is very active, especially if he/she plays a sport that involves a lot of running and jumping on hard surfaces (such as soccer, basketball, or gymnastics), it can put extra strain on the already overstretched tendons. This leads to swelling and pain at the point where the tendons attach to the growing part of the heel.

This growth spurt can begin any time between the ages of 8 to 13 for girls and 10 to 15 for boys. Sever’s disease rarely occurs in older teens because the back of the heel usually finishes growing by the age of 15, when the growth plate hardens and the growing bones fuse together into mature bone by the process of secondary ossification.

Sever's Disease Symptoms, Causes.


Sever’s Disease Causes

Overuse and stress on the heel bone through participation in sports is a major cause of calcaneal apophysitis. Other potential causes of calcaneal apophysitis include obesity, a tight Achilles tendon, and bio-mechanical problems such as flatfoot or a high-arched foot. The main factors thought to predispose a child to Sever’s disease include:

  • Decrease ankle dorsiflexion.
  • Abnormal hind foot motion e.g.over pronation or supination.
  • Tight calf muscles
  • Excessive weight-bearing activities e.g. running

Signs and Symptoms

Generally, the main warning signs of Sever’s disease are:

  •  Sore heels
  • Intense pain after physical activity
  • Limping/tiptoeing gait
  • Swelling and redness in the heel, which however are rarely evident

Physical Therapy Treatment for Sever’s Disease

The immediate goal of treatment is pain relief. Because symptoms generally worsen with activity, the main treatment for Sever’s disease is rest, which helps to relieve pressure on the heel bone, decreasing swelling and reducing pain. Physical therapist may treat the Sever’s by following means:

RICE Therapy

The initial treatment for a musculoskeletal disease is to follow the traditional RICE therapy. The first thing to do is restthen apply ice (wrapped in a towel, not applied directly to the skin) to the injured heel for 20 minutes two or three times per day, even on days when the pain is not that bad, to help reduce swelling. Use an elastic wrap or compression stocking that is designed to help decrease pain and swelling and elevate the effected foot.


Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot.

Support or Braces

To support and protect your heels, you may need to be wear shock absorbing heel cups or a soft orthotic. Heel lifts, Orthoses (all types, heel cups and heel foam), padding for shock absorption or strapping of heel to decrease impact shock is recommended. It is also advised to wear supportive shoes.


Kinesio foot taping by a physiotherapist will be helpful to provide pain relief.

Electrical Stimulations

Electrical Stimulations in the form of Russian stimulation sine wave modulated at 2500 Hz with a 12 second on time and an 8 second off time with a 3 second ramp.

Therapeutic Ultrasound

Therapeutic Ultrasound could be applied to speed up the healing process and to improve circulation.

Casting or Crutches

Physiotherapist will recommend castings (more than 2-4 weeks) and crutches in severe cases.


Ketoprofen Gel or other analgesic gels could be recommended by a physiotherapist as an addition to treatment

Muscle Stretching’s

Some of the most popular stretches for dealing with Sever’s disease; considering that these exercises are mostly carried out by children, it is vital that they are performed in a controlled manner and under supervision by an expert, at least during the first attempts

Hamstring Stretching

Hamstring muscles in many cases are blame for Sever’s diseases, the classic seated hamstring stretch, can offer valuable help.

Calf Muscle Stretching

Stiff calf muscles can be loosened by stretching. For that stand in front of a wall, leaning towards it while pushing your hips forward.

Gastrocnemius Stretching

Lie supine, life the leg without bending the knees to limit you can life. This procedure is generally known as Straight Leg Raise (SLR) and it will cause gastrocnemius to stretch.

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