What is Sever’s "disease" and what causes it?
- Alison Gould
- Nov 30, 2025
- 8 min read
Sever’s disease is the most common cause of heel pain in teenagers – especially if they’re active and going through a growth spurt. Learn what is Sever’s disease, what causes it, and how to recognise it in your child. Also, why Sever’s is not really a “disease”.
Remember, if you need help with an Achilles injury, you're welcome to consult one of our team via video call.
In this article:
We've also made a video about this:
What is Sever’s disease?
Sever’s disease is actually not a disease at all. It's not something that you can catch; it's not something that you can pass on; it's not something that's going to be a life-long problem. The term is misleading and can cause unnecessary worry.
Here’s what Sever’s really is: Children have growth plates in their bones; this is how their bones get bigger and longer as the child grows. Bones grow faster than muscles and tendons, and this causes increased tension (pulling) where a tendon attaches onto the growth plate part of a bone, which can cause it to become inflamed and irritated.
💡 In medical jargon, this is called traction apophysitis – meaning irritation and inflammation where a tendon pulls on a growth plate (apophysis).
In the case of Sever’s, the child’s bone growth has outpaced the growth of their calf muscles and/or Achilles tendon, and then the Achilles tendon pulls on the growth plate at the back of the heel bone.
In some cases, other soft tissue higher up in the leg and body, like their nerves, also contributes to this tension – more on this later.
The typical age range for Sever’s is from 9 to 15 years, but any growing child can get it.
What causes Sever’s in some kids?
Two main factors work together to predispose a child towards Sever’s: When they lead a very active life, and when they’re going through a growth spurt.
Active children
Children in the age range 9 to 15 are usually quite active. For example, they have PE at school, they might play sports at school, they might play sports for clubs outside the school environment, and they might walk to and from school.
These activities would involve actions such as running, jumping, hopping, and going up on your tiptoes, all of which require strong contractions of the calf muscles, which then cause the Achilles tendon to pull on the heel bone.
👉 Now remember, this isn't a bad thing. Being active and doing sport is good for kids.
But this does make active children – especially those doing sports several times per week – more likely to get Sever’s. It is rare in sedentary children.
Growth spurts
Growth spurts also play a major role, for obvious reasons. Signs of a growth spurt include:
rapid height increases
outgrowing shoes quickly
loose or falling-out teeth (due to a change in the shape of the jawbone)
temporary clumsiness or lack of coordination (due to muscles, tendons, and nerves not growing as fast as the bones).
Additional factors
Foot posture
This has not yet been researched, but in our clinical experience excessive foot pronation (rolling in of the foot when walking and running) might contribute to a kid getting Sever’s disease, especially if the pain is more towards the inner side of the back of the heel.
Excessive pronation can increase the pulling or strain on the inner (medial) part of the Achilles tendon as the foot rolls in, which can cause the pain and irritation to develop more towards the inner edge of the back of the heel.
This is why we always check children’s foot posture, flexibility, and movement patterns to see what might be causing their specific case when we assess them for heel pain via our video consultations.
Neural tension
It’s not just children’s muscles and tendons that might be temporarily outgrown by their bones; it could also be their nerves.
The nerves in our calf muscles are all connected to the central nervous system, with the brain and the spine at its core. If the nerves are stretched too much anywhere along this pathway (referred to as neural tension), it would cause tightness in the calf muscles which, in turn, could increase the pull that the Achilles tendon exerts on the growth plate in the heel bone.
Here’s a demo of a test for neural tension that you can do at home with your child – we also guide the children we assess through this via video call:
Is Sever's disease genetic?
No. Sever’s is not genetic and cannot be passed on, so family history does not directly increase the risk of getting it.
However, being from a tall family might mean that a child is more likely to grow rapidly, and therefore indirectly more prone to Sever’s – but this is not a given.
Symptoms – How do you know it is Sever’s?
As indicated above, Sever’s is rare in children that are not very active and are not experiencing a growth spurt.
With Sever’s:
The heel is very tender right where the Achilles tendon attaches into the heel bone.
The pain usually gets worse during or after activities that use the calf muscles, e.g. running or jumping or walking for long periods.
Children might be limping directly after an activity or later that day.
Sometimes, they don't even want to put weight on their heel and walk on their tiptoes.
These symptoms can be in one or both heels.
When we as physiotherapists assess a child with suspected Sever’s disease, we would look out for the typical profile for getting the injury, such as the age of the child, a possible recent growth spurt, activity levels, how the pain reacts to different activities vs. rest, and exactly where the pain is.
We would also rule out other possible causes of the problem to make sure we are treating the right thing and then look at other things that could be linked with these symptoms, such as tightness in the calf or foot muscles, neural tension, ankle mobility, and excessive pronation.
👉 Two conditions that might be mistaken for Sever’s are:
Sever’s vs. Achilles tendonitis
Achilles tendonitis affects the Achilles tendon itself, while Sever’s affects the growth plate. Achilles tendonitis is very rare in children, because overuse of the tendon is much more likely to injure the growth plate than the tendon itself.
Sever's vs plantar fasciitis
Plantar fasciitis pain is located at the underside of the foot, where the plantar fascia attaches to the bottom front of the heel bone, while Sever’s pain is felt at the bottom of the back of the heel.
Of course, a child can have Sever’s and plantar fasciitis.
How long does Sever’s last?
The good news is that children will literally grow out of it, so it is not permanent.
However, how long a bout of Sever’s lasts depends on how it is managed. If you ignore it and the child continues to irritate it and the causes aren’t dealt with, it can continue for many months.
If you allow it to calm down and take steps to address the causes, it can be managed down in 6 to 12 weeks – sometimes longer in cases where the irritation of the growth plate is very severe.
In many cases, the child doesn't have to stop doing all their sports to recover – they just have to adjust things to decrease the pulling to a manageable level. (We will soon publish our comprehensive article on the best treatment for Sever’s and explain this concept of load management in more detail.)
Can Sever’s cause permanent damage?
Sever’s rarely causes permanent damage. It is only in extreme cases where a child really pushes through strong pain for very long periods and continues doing high-impact sports during that time that it might cause the growth plate to pull away from the bone.
But in the vast majority of cases, it doesn’t cause permanent problems if the child follows a sensible treatment plan and stays active within the limits set by their pain and symptoms. (More on this in our treatment article to come.)
👉 Sever's is one of the injuries that our team can successfully assess and treat via Video Call. You can find more information about our online treatment process here.
Can Sever’s come back?
Yes. Recurrence is possible. A child might feel better, return to sport, and then symptoms might flare up again – particularly if they are still going through a growth spurt and the growth plate is active.
We will discuss how to reduce the chances of recurring Sever’s in our treatment article.
Can adults get Sever’s?
Our growth plates disappear around the age of 18, so adults don’t get Sever’s, but they can get other injuries to the Achilles tendon in that area
The most common cause of this type of heel pain in adults is insertional Achilles tendonitis or tendinopathy. If you’re an adult and you’re experiencing pain in the Achilles area, you’re welcome to consult our vast collection of articles on Achilles injuries – a good place to start is our article on the symptoms and causes of Achilles tendonitis or tendinopathy.
How we can help
Need help with a possible Sever's or Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an injury assessment and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. All of us have a wealth of experience working with athletes across a broad variety of sports and ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Alison Gould is a chartered physiotherapist and holds an MSc in Sports and Exercise Medicine. You can follow her on LinkedIn, Facebook, Instagram, and Twitter.
