By Jeff Stewart – Podiatrist (B.Pod La Trobe, M.A.Pod.A NSW) | Manly Cove Podiatry
It is a scene I see regularly at Manly Cove Podiatry, an active Northern Beaches kid limping off the football field at Manly or Balgowlah, wincing through surf club runs at Queenscliff or Freshwater, or refusing to walk to school the morning after a big training session. The heels are sore, the parents are worried, and more often than not they have been told it is probably just growing pains.
Sometimes that is true. But heel pain in active children is very often something more specific – a condition called Sever’s disease – and the two are not the same thing. Understanding the difference matters, because Sever’s disease responds very well to treatment, and there is no good reason for a child to spend months limping through sport when the problem is entirely manageable.
What Is Sever’s Disease?
The Basics
Despite the name, Sever’s disease is not actually a disease. It is an overuse injury at the growth plate at the back of the heel – a condition called calcaneal apophysitis. The name comes from Dr James Warren Sever, who first described it in 1912.
Why It Happens During Growth Spurts
During a growth spurt, the heel bone can grow faster than the Achilles tendon is able to keep up. This leaves the tendon temporarily tight, pulling hard on the growth plate at the back of the heel with every step. Add the repetitive impact of running, jumping, and kicking, and that growth plate becomes inflamed and painful.
Sever’s disease most commonly affects children between the ages of eight and fourteen – the peak years for growth plate activity. It is more common in boys, but girls are frequently affected too. On the Northern Beaches where children tend to be very physically active – surf club, football, netball, athletics – children’s heel pain from Sever’s disease is something we see consistently throughout the year.
Is It Growing Pains or Sever’s Disease? How to Tell the Difference
The Key Question
This is one of the most important distinctions for parents to understand. Ask yourself: does the heel pain appear during or after physical activity, and ease off with rest – only to return next time your child is active? If yes, that pattern points strongly to Sever’s disease rather than growing pains, and it is worth getting it assessed by a children’s podiatrist.
At a glance
| Growing Pains | Sever’s Disease | |
|---|---|---|
| Location | Calves or thighs | Heel – specifically at the back and base |
| When it occurs | At night, unrelated to activity | During or after sport and physical activity |
| Improves with | Morning – usually gone by breakfast | Rest – but returns when activity resumes |
| Age range | Broad – common in younger children | Typically 8 to 14 – peak growth spurt years |
| Cause | Not fully understood | Achilles tendon pulling on immature growth plate |
Why the Distinction Matters
Growing pains are generally benign and self-resolving. Sever’s disease, while also self-limiting in the long run, causes real pain that disrupts sport, sleep, and daily activity – and it responds well to targeted treatment. A child struggling with Sever’s disease does not need to wait years for their growth plates to fuse. With the right approach, most children improve significantly within a few weeks.
Why Is My Child Getting Children’s Heel Pain Now?
Growth Spurts and Activity Spikes
The timing usually comes down to a combination of a growth spurt and a spike in activity. The heel bone is growing quickly, the Achilles tendon temporarily lags behind, and the repetitive load of sport does the rest. On the Northern Beaches, where children train year-round across multiple sports and the surf club season runs from October through March, we see this pattern consistently at Manly Cove Podiatry.
Factors That Increase the Risk
- Tight calf muscles: very common in fast-growing children, and they significantly increase the pulling force on the growth plate
- Flat feet or poor foot mechanics: can alter how load travels through the heel, adding stress on the growth plate
- A sudden increase in training load: starting a new sport season, ramping up training, or playing on hard surfaces
- Unsupportive footwear: thin-soled shoes or thongs that offer no heel cushioning
Family history plays a role too. If one or both parents had heel pain as a child, there is a reasonable chance their children will be more prone to it.
Will Sever’s Disease Just Go Away on Its Own?
Technically Yes – But That Is Not a Good Reason to Wait
Sever’s disease is self-limiting. The growth plate eventually fuses, usually in the mid-teens, and the condition resolves. But waiting it out means a child can spend a year or more in unnecessary pain, dropping out of sport or significantly modifying how they move to avoid discomfort.
Those compensatory movement patterns can cause secondary problems in the ankles, knees, and lower legs. A child who stops enjoying sport due to heel pain can develop habits and attitudes toward activity that are hard to reverse. With the right Sever’s disease treatment, most children improve significantly within a few weeks – there is no good reason to wait.
Sever’s Disease Treatment at Our Manly Podiatry Clinic
What Treatment Looks Like
Treatment is conservative throughout – there is no surgical option for Sever’s, and none is needed. The goal is to reduce the load on the growth plate while keeping the child as active as possible. A complete ban on sport is rarely necessary and often counterproductive.
At Manly Cove Podiatry, treatment typically involves some combination of the following depending on what is driving the problem:
- Heel raises and heel cups: reduces the stretch on the Achilles tendon and takes pressure off the growth plate. Often one of the first things we try, and frequently very effective
- Stretching program: targeted calf and Achilles stretching to reduce the tension pulling on the growth plate. We show you and your child exactly what to do and how often
- Load management: working out how much activity is appropriate and how to modify training without stopping altogether. This is usually more nuanced than simply resting completely
- Footwear advice: the right shoes make a meaningful difference. Some footwear significantly worsens Sever’s disease; others provide the heel cushioning and support that helps it settle
- Orthotics: where flat feet or poor foot mechanics are contributing to the load through the heel, orthotics can correct the underlying issue and take sustained pressure off the growth plate
Signs It Is Time to Get It Checked
It is worth booking an assessment if your child:
- Complains of heel pain during or after sport
- Is limping, tiptoeing, or walking differently to avoid heel pain
- Has been told it is growing pains but the pain keeps returning
- Is avoiding sport or asking to sit out of training
- Has pain that is getting worse rather than settling with rest
At Manly Cove Podiatry, Sever’s disease is one of the most common conditions we treat in children across Manly, Balgowlah, Freshwater, Seaforth, and the wider Northern Beaches. The good news is that it responds well to straightforward treatment, and in the right hands most children are back to full activity quickly. If your child is struggling with heel pain, do not wait for it to resolve on its own – come in and let us take a look.
Book a shin splints assessment at Manly Cove Podiatry
Phone: (02) 8966 9552
Address: Suite 12, 35-36 East Esplanade, Manly NSW 2095
Hours: Monday to Friday 8am-6pm, Saturday 8am-12pm
Saturday appointments available – no referral needed
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