Sever's disease
Sever's disease is a growth-related painful condition affecting the growth plate of the heel bone. It mainly affects growing children and adolescents who do a lot of running and jumping. Symptoms often develop gradually and worsen with running, sprinting, jumping and changes of direction. The condition usually resolves over time but may recur during the growth period.
Mild pain at the back or underside of the heel that mainly occurs during running, jumping or after training. The player can usually walk normally and has no or only mild tenderness during daily activities. Symptoms often decrease with rest.
Sever's disease occurs when the load around the heel bone's growth plate exceeds the area's tolerance. Pulling forces from the Achilles tendon and repeated impact during running and jumping contribute to symptoms. The condition occurs mainly during periods of rapid growth.
Common contributing factors
- •Rapid growth and changing loads on muscles, tendons and bones.
- •High volumes of running, sprinting, jumping and changes of direction.
- •Rapid increases in training volume or intensity.
- •Insufficient recovery between training sessions and matches.
- •Tight calf muscles or limited ankle mobility may contribute to increased loading.
- •Football boots with inadequate cushioning or fit may aggravate symptoms in some players.
Sever's disease cannot always be prevented during a growth period. The aim is to adapt loading to the player's symptoms and recovery and avoid increasing training volume too quickly.
- •Increase training volume and intensity gradually, especially during rapid growth.
- •Plan recovery between matches and training sessions involving substantial running and jumping.
- •Use football boots with an appropriate fit and comfortable cushioning.
- •Maintain calf and foot strength and mobility without provoking pain.
- •Respond early to recurring heel pain and adjust loading before the player starts limping.
Temporarily reduce running, sprinting, jumping and other activities that provoke pain. The player may continue pain-free, low-impact activities such as cycling or swimming. Cold therapy with a towel between the skin and the cold pack may be used for short-term pain relief after activity.
Symptom control and modified activity
Modify training so that heel pain does not progressively increase. Assess the player's response during activity, later that day and the following morning. Pain-free activities may be maintained.
Goals
Pain decreases and the player can walk normally without limping.
Progression criteria
Walking during daily activities is pain-free or nearly pain-free, and symptoms do not worsen after modified activity.
Strength and gradual return to running
Gradually reintroduce light running and simple football drills. Individually adapted calf and foot strengthening and gentle calf stretching may be used when appropriate. Avoid exercises that clearly increase pain.
Goals
Restore pain-free load tolerance and normal movement.
Progression criteria
Light running and football drills can be completed without limping or a clear increase in symptoms afterward.
- The player walks normally without pain or limping.
- Running and basic football drills can be completed without a clear increase in pain.
- The heel does not develop a clear increase in symptoms later that day or the following morning.
- Higher-intensity training and full team training are reintroduced gradually.
The information in the Injury Center is for educational purposes and does not replace professional medical advice. Always consult a qualified healthcare professional for diagnosis and treatment.
Sever's disease
Sever's disease is a growth-related painful condition affecting the growth plate of the heel bone. It mainly affects growing children and adolescents who do a lot of running and jumping. Symptoms often develop gradually and worsen with running, sprinting, jumping and changes of direction. The condition usually resolves over time but may recur during the growth period.
Mild — Lindriga besvär kan förbättras inom några veckor med anpassad belastning, men symtomen kan återkomma under tillväxtperioden. Återgången styrs av funktion och symtom snarare än ett fast antal dagar.
Symptoms
Mild pain at the back or underside of the heel that mainly occurs during running, jumping or after training. The player can usually walk normally and has no or only mild tenderness during daily activities. Symptoms often decrease with rest.
Acute Treatment
Temporarily reduce running, sprinting, jumping and other activities that provoke pain. The player may continue pain-free, low-impact activities such as cycling or swimming. Cold therapy with a towel between the skin and the cold pack may be used for short-term pain relief after activity.
Rehabilitation
Modify training so that heel pain does not progressively increase. Assess the player's response during activity, later that day and the following morning. Pain-free activities may be maintained.
Goals
Pain decreases and the player can walk normally without limping.
Progression criteria
Walking during daily activities is pain-free or nearly pain-free, and symptoms do not worsen after modified activity.
Gradually reintroduce light running and simple football drills. Individually adapted calf and foot strengthening and gentle calf stretching may be used when appropriate. Avoid exercises that clearly increase pain.
Goals
Restore pain-free load tolerance and normal movement.
Progression criteria
Light running and football drills can be completed without limping or a clear increase in symptoms afterward.
Return to Play
- ☐ The player walks normally without pain or limping.
- ☐ Running and basic football drills can be completed without a clear increase in pain.
- ☐ The heel does not develop a clear increase in symptoms later that day or the following morning.
- ☐ Higher-intensity training and full team training are reintroduced gradually.
Moderate — Besvären kan kräva flera veckors belastningsanpassning eller längre. Förloppet varierar med tillväxt, symtomens varaktighet och hur väl belastningen kan anpassas. Återkommande besvär är möjliga under tillväxtperioden.
Symptoms
More noticeable heel pain during running, jumping and football training. The player may begin to alter their running pattern or experience pain when walking after activity. Symptoms may affect several training sessions and recur when loading increases.
Acute Treatment
Pause or reduce running, sprinting, jumping and match play that provoke pain. Replace these with pain-free, low-impact activities when appropriate. Assessment by a physiotherapist or other healthcare professional is appropriate if symptoms affect walking, recur frequently or do not improve with load modification.
Rehabilitation
Reduce impact loading until walking and daily activities can be performed without a clear increase in pain. Comfortable footwear and a heel cup may help some players. Assessment should also consider other causes of heel pain when symptoms are atypical or persistent.
Goals
Pain decreases and normal walking is restored without compensation.
Progression criteria
The player can walk normally and complete daily activities without a clear increase in pain.
Reintroduce strengthening exercises followed by light running when symptoms allow. Increase one loading factor at a time, such as duration, speed or the amount of change-of-direction work. Monitor symptoms during and after training.
Goals
Tolerate increasing loads without limping or recurrent worsening.
Progression criteria
Running and progressively more football-specific training can be completed without a clear increase in symptoms that day or the following morning.
Return to Play
- ☐ The player can walk and perform daily activities normally.
- ☐ Running, acceleration and controlled jumping can be completed without a clear increase in pain.
- ☐ Football-specific drills and changes of direction are introduced gradually.
- ☐ Full team training resumes when loading is tolerated without limping or recurrent worsening.
- ☐ If pain persists or repeatedly returns, the player should be assessed by a healthcare professional.
Severe — Återhämtningen kan ta flera veckor eller längre, beroende på orsaken till symtomen och hur mycket belastningen behöver minskas. Kraftig eller långvarig smärta ska bedömas innan en prognos ges.
Symptoms
Severe heel pain that limits walking or causes marked limping or toe-walking to avoid loading the heel. Pain may also occur during daily activities. Severe pain should not automatically be attributed to Sever's disease, as a stress fracture or another injury can cause similar symptoms.
Acute Treatment
Stop running, jumping and football activities that load the heel. The player should be assessed promptly by a healthcare professional if pain is severe, limping is marked or weight-bearing is difficult. Prompt medical assessment is particularly important after acute trauma, rapidly worsening pain or marked swelling and redness.
Rehabilitation
Exclude other causes of severe heel pain before planning rehabilitation. Loading is adjusted according to the medical assessment and the player's ability to walk without significant pain. Temporary support or additional offloading may be recommended by a healthcare professional when needed.
Goals
Establish the cause of the pain and restore pain-free or clearly improved walking function.
Progression criteria
More serious causes have been assessed and the player can load the foot according to healthcare recommendations.
Rebuild loading gradually through daily walking, appropriate strengthening exercises, light running and then football-specific activities. If severe pain persists or recurs, the plan should be reassessed by a healthcare professional.
Goals
Restore normal function and tolerate football running, jumping and changes of direction without recurrent symptoms.
Progression criteria
The player tolerates progressively more demanding activity without limping or a clear increase in symptoms and follows any individual healthcare plan.
Return to Play
- ☐ Other possible causes of severe heel pain have been assessed.
- ☐ The player walks normally without pain or limping.
- ☐ Running, jumping, acceleration and changes of direction can be reintroduced gradually without a clear increase in symptoms.
- ☐ Full team training and match play resume only when football-specific loading is well tolerated.
- ☐ Follow healthcare recommendations if another injury has been identified.
When to Seek Medical Care
Heel pain in growing athletes is often load-related, but other conditions can cause similar symptoms. Seek medical care if pain is severe, affects walking or does not improve with modified loading.
- The player cannot bear weight normally or is markedly limping.
- Pain started after a clear traumatic event or is worsening rapidly.
- The heel is markedly swollen, red or warm.
- Pain occurs at rest or at night, or progressively worsens.
- The player has a fever or feels generally unwell.
- Symptoms persist despite load modification or repeatedly recur.
References
- Sever's disease – children and young people — Sydney Children's Hospitals Network (https://www.schn.health.nsw.gov.au/factsheets/severs-disease)
- Heel Pain and Sever's Disease — American Academy of Pediatrics (https://www.healthychildren.org/English/health-issues/injuries-emergencies/sports-injuries/Pages/Heel-Pain-and-Severs-Disease.aspx)
- Sever's disease – treatment, symptoms and causes — Healthdirect Australia (https://www.healthdirect.gov.au/severs-disease)