Pain guide · Foot pain

Sever's disease: heel pain in active children, and how to keep them playing

Sever's disease is pain at the back of the heel in active children, usually aged 8 to 15, where the Achilles tendon pulls on a growth area of the heel bone. It hurts during and after running and jumping and eases with rest. Despite the name, it's an overuse injury rather than an illness, children recover completely, and it stops once the heel finishes growing.

This guide is for parents and children. In trials, waiting, a heel raise and an exercise programme all helped about equally, so most children can keep playing with a few changes: less running and jumping while it's sore, heel cups, daily calf stretches and some strength work. An NHS children's hospital leaflet suggests keeping pain during activity to 3 out of 10 or less. The guide starts with the signs that mean heel pain is something else.

3-stage exercise plan When to get help 22 sourcesUpdated 21 October 2026

When to get help first

Exercise is for pain that has been checked or is clearly mild and settling.

Get urgent medical help if

Pain, swelling, redness and warmth over a bone, or a very high temperature with feeling generally unwell: ask for an urgent GP appointment or contact NHS 111. It could be a bone infection. Take your child to a GP if they don't want to use a leg and seem irritable: young children don't always get a high temperature with a bone infection.
After a jump, landing or fall: contact NHS 111 if there was a snap, grinding or popping noise, the heel pain is severe, the foot has changed shape, or your child can't walk, walk on tiptoe or climb stairs.
A child or teenager with sudden pain in the hip, thigh or knee, or who suddenly can't put weight on one leg: ask for an urgent GP appointment or call NHS 111 the same day. Hip problems in children can be felt only in the thigh or knee.

See a doctor or physiotherapist if

Heel pain that keeps coming back with sport: see a GP or physiotherapist once, to confirm it's Sever's disease. It's usually diagnosed from the story and a heel squeeze, without an X-ray.
Leg pain in the morning, pain bad enough to stop your child walking, a rash, swelling or unusual bruising, a high temperature, unusual tiredness, or not eating or losing weight: see a GP. A limp during and after sport fits Sever's disease; a limp that carries on away from sport, or pain in one joint such as the knee or ankle, needs checking.
Bone pain or tenderness, particularly if it's worse at night, or a lump or swelling: see a GP.
A child's heel pain that isn't clearly linked to activity, or that comes with swelling, redness or a fever.
No improvement after 6 weeks of the advice on this page, or pain that is stopping your child enjoying sport.

Understand it

What it is

The Achilles tendon attaches to the back of the heel bone, close to a growth area called the calcaneal apophysis. Repeated running and jumping strain it and it becomes sore, which doctors call calcaneal apophysitis. It is the commonest cause of heel pain in children aged about 8 to 15.

Despite the name, it's an overuse injury rather than an illness. A children's hospital fact sheet calls it a small injury where the calf tendon attaches to the heel bone, sport is unlikely to cause any permanent damage, and children recover completely with no long-term problems.

Sources 1, 2, 3, 4

What's normal growthEmerging evidence

The heel's growth area appears between about 6 and 12 in girls and 8 and 14 in boys, and fast growth in these years is thought to be part of why heel pain appears then. On MRI (magnetic resonance imaging) scans of 164 children, the growth area began to fuse to the rest of the bone at about 12, and had finished fusing in 78% of 14 and 15 year olds and 88% of 15 to 18 year olds.

A normal growing heel can look abnormal on scans. On MRI, the growth area showed bright patches in 30% of children and lines that can be mistaken for a fracture. On X-rays, it normally looks dense and in pieces, and those features can't make the diagnosis.

Sources 4, 5, 6, 7

What's normal for Sever's disease, and what isn't

Normal for it: heel pain during or after sport, especially running and jumping, that eases with rest; usually no pain in the morning or after rest; one or both heels (both in 61% of 85 children in an older series); pain when the heel is squeezed; sometimes a limp or walking on tiptoe because of the pain; and a flare in growth spurts.

Growing pains are different: an aching or throbbing in both legs, usually in the evening or at night and gone by the morning, in children aged 3 to 12. They're more common in active children, but they aren't felt in one heel during sport.

Not normal for it: pain at night or first thing, pain in one joint, a limp that carries on away from sport, a hot, red or swollen heel, a high temperature, unusual tiredness, weight loss, or a lump. The NHS asks parents to see a GP for these, and the warning signs at the top of this page give the details.

Sources 2, 1, 8, 9, 10, 11

Who gets it

In Dutch general practice records, 3.7 of every 1,000 registered children aged 6 to 17 had been diagnosed with it. It is more common in boys, who made up 73% of children in the trials, and in children who do frequent high-impact sport such as football, basketball and athletics, or who specialise early in one sport.

A study of risk factors found no evidence that weight or activity level are risk factors, but children in an Australian trial were heavier and taller than average, and older children and those who had had pain longer reported worse pain. Tight calves are often blamed, but a Cochrane review notes that the idea that the shin bone grows faster than the calf muscles can lengthen is unlikely, on current research.

Sources 12, 13, 4, 1, 14, 15

How it's recognisedEmerging evidence

From the story and a heel squeeze. Children's physiotherapists and a children's hospital say X-rays and scans are usually only needed to rule out something else. In 61 children, routine X-rays changed the diagnosis only once (a non-cancerous bone cyst), and surgeons couldn't reliably pick out Sever's disease from X-rays alone. A US series that found other problems (bone cysts, a non-cancerous tumour and stress fractures) in 5% of 98 children argued for an X-ray, so a doctor may want one if the pain doesn't fit the usual pattern.

Sources 1, 3, 4, 6, 7, 16

How long it lasts

Most children get better over time. Children's physiotherapists say the pain usually goes within a few months, though some symptoms last 12 to 24 months; a children's hospital says 6 to 12 months, sometimes up to 2 years. It can come back with the next growth spurt and stops once growth ends. In the Australian trial, children had already had pain for about 9 to 12 months on average. Parents tend to rate its impact as worse than their children do at first.

Sources 4, 1, 3, 2, 17

What helps, and how strong the evidence is

Every option tested so far did about as well as waitingEmerging evidence

In a Dutch trial of 101 children aged 8 to 15, waiting (stopping painful activity and starting again when the pain settled), a silicone heel-raise insert and a supervised calf exercise programme, for 10 weeks, all reduced heel pain, with no clinically important difference at 3 months; the heel-raise group was more satisfied at 6 weeks.

In an Australian trial of 124 children aged 8 to 14, a 6 mm heel raise did slightly better than a ready-made orthosis on one measure at 1 and 2 months, nothing differed at 6 and 12 months, and new shoes made no difference.

A 2026 Cochrane review of 10 trials (654 children, 7 trials on Sever's disease) rated most of the evidence low or very low certainty. Orthoses and heel lifts likely make little or no difference against each other (moderate certainty), the effect of taping is very uncertain, and no trial has tested stretching on its own. Because children improve as they grow, it is hard to separate treatment from natural recovery.

Sources 18, 19, 4, 20

Insoles and heel cups while playingEmerging evidence

In a Swedish study of 38 very active boys who kept up their usual sport, pain during sport was lower while wearing insoles (a heel cup or a heel lift) than without them. NHS leaflets suggest shock-absorbing insoles or gel heel cups, and supportive, cushioned trainers.

Sources 21, 2, 1

Keeping children playing, within limitsEmerging evidence

UK leaflets agree that sport is unlikely to cause lasting damage, though it may make the pain worse. A Cambridge NHS leaflet says the child can keep playing, though the pain may take longer to settle. Children's physiotherapists advise reducing how long, how often and how much, especially running and jumping, after a period of rest at first, and a complete break for a while only if pain stays severe. NHS Lothian's children's hospital says continuing sport at a lower level isn't harmful as long as it doesn't increase the pain. No trial has made children stop sport; in the Dutch trial, the waiting group restarted when the pain allowed.

Sources 2, 1, 13, 3, 18

Stretching and strengthening: widely advised, untested on their ownMixed evidence

NHS leaflets advise daily calf stretches, and NHS Lothian adds a strength programme with targets. No trial has tested either on its own. In an older series of 85 children treated with calf stretching, strengthening of the muscles that lift the foot, and soft insoles or heel cups, all improved and went back to their sport about 2 months after diagnosis, with 2 recurrences, but there was no comparison group. The shin exercise in this plan is our editorial choice, based on that series and on children's physiotherapists listing weak shin muscles as a risk factor.

Sources 4, 13, 2, 8, 1

What isn't neededMixed evidence

Casts and walking boots, which some US websites suggest, have no trial support in the reviews. No trial has tested injections for Sever's disease; the injection trials in the Cochrane review were for the knee version (Osgood-Schlatter disease). Ready-made orthoses did no better than a simple heel raise, and new shoes made no difference.

Sources 4, 20, 19

How much pain is OK while you exercise?

No more than 3 out of 10 during activity (an NHS children's hospital leaflet)Emerging evidence

NHS Lothian's Royal Hospital for Children and Young People says pain during activities should be no more than 3 out of 10, where 0 is no pain and 10 is severe pain. A little discomfort during the exercises is normal as long as it settles after stopping, and on the way back to sport, a little pain is OK if it settles quickly after exercise.

Check during sport, straight after and the next morning, and if the heel is sorer the next day, cut back for a few days (both our suggestions). A Cambridge NHS leaflet adds that the pain may take longer to settle if your child keeps playing, and children's physiotherapists suggest a complete break for a while only if pain stays severe.

This rule comes from one NHS leaflet, not a trial. It is a little more relaxed than the 0 to 2 used in this site's Osgood-Schlatter guide, which comes from a study of knee pain.

Sources 13, 2, 1

The exercise plan: 3 stages

Start at the first stage. Each move opens a full guide with a 3D demo.

Stage 1

Ease the heel and stay active (about weeks 0 to 2)

Cut back the running and jumping that hurts, not all sport; swim, cycle or climb while it's sore, as NHS leaflets suggest. Use gel heel cups or cushioned insoles and cushioned trainers, ice for 10 to 15 minutes after sport if it helps, and avoid barefoot sport while it's sore. Doses are from NHS Lothian or are editorial.

Wall calf stretch (gastrocnemius) demonstrated on the 3D figure

3D demoWall calf stretch (gastrocnemius)Beginner · A wall

Hold for at least 30 s, 3 times each side, every day · NHS Lothian's dose. Stretch when it isn't sore, as children's physiotherapists advise

Easier: Seated calf stretch with a towel · Harder: Contract-relax hamstring stretch (PNF)

Soleus wall stretch demonstrated on the 3D figure

3D demoSoleus wall stretchBeginner · A wall

Hold for at least 30 s, 3 times each side, every day · The bent-knee calf stretch from the same leaflet

Easier: Seated calf stretch with a towel · Harder: Contract-relax hamstring stretch (PNF)

Seated bent-knee calf raise (soleus raise) demonstrated on the 3D figure

3D demoSeated bent-knee calf raise (soleus raise)Beginner · A bench or box

2 sets of 15 · A gentle start; editorial

Harder: Slow calf raise

Stationary cycling demonstrated on the 3D figure

3D demoStationary cyclingBeginner · Cardio machine

15 to 30 min, or a bike ride outside · Cycling is suggested by an NHS leaflet; the time is editorial

Harder: Air bike intervals

Move on when: Walking and school PE are comfortable, and sport stays at 3 out of 10 or less.

Follow along: a timer, a cue and the next move, one step at a time.

Stage 2

Build calf strength (about weeks 2 to 6)

Strength work about a minute at a time, as NHS Lothian suggests, while sport builds back. Keep the stretches going daily.

Slow calf raise demonstrated on the 3D figure

3D demoSlow calf raiseBeginner · A wall

About 1 minute at a time · On both feet, with a soft ball or rolled-up socks between the ankles. Start on the floor, then on the bottom stair with the heels lowering below the step and a hand on the banister (NHS Lothian)

Easier: Seated bent-knee calf raise (soleus raise) · Harder: Standing dumbbell calf raise

Single-leg calf raise from a step demonstrated on the 3D figure

3D demoSingle-leg calf raise from a stepIntermediate · A step + A wall

Build to just under double your age in a row, on each leg · NHS Lothian's target: about 20 at age 11. On flat ground first, then off a step; do some with the knee bent too

Easier: Slow calf raise · Harder: Single-leg pogo hops

Reverse lunge demonstrated on the 3D figure

3D demoReverse lungeIntermediate · No equipment

2 sets of 8 each leg · Lunges are in NHS Lothian's programme; reverse lunges first, then walking lunges, is our order

Easier: Split squat · Harder: Split squat with dumbbells

Tibialis raise demonstrated on the 3D figure

3D demoTibialis raiseBeginner · No equipment

2 sets of 10 to 15 · Our editorial choice: an older programme strengthened the muscles that lift the foot, and children's physiotherapists list weak shin muscles as a risk factor

Harder: Single-leg tibialis raise

3D demoWall calf stretch (gastrocnemius)Beginner · A wall

Keep going daily · NHS Lothian

Easier: Seated calf stretch with a towel · Harder: Contract-relax hamstring stretch (PNF)

Move on when: Your child is close to the single-leg target on both legs and can hop, skip and jump quietly without pain, which is NHS Lothian's check for being ready for sport.

Follow along: a timer, a cue and the next move, one step at a time.

Stage 3

Back to full sport (from about week 4 to 6)

Restart one activity or training session a week. Keep to no more than 4 high-intensity sessions a week, not on 2 days in a row, and total hours of organised sport a week no more than your child's age (NHS Lothian's limits). The hop, skip and jump doses are editorial.

Ankle bounces (mini pogo) demonstrated on the 3D figure

3D demoAnkle bounces (mini pogo)Beginner · No equipment

2 sets of 20, with quiet landings · The leaflet's hop check

Harder: Pogo hops

3D demoSkippingBeginner · No equipment

3 runs of 20 m · The leaflet's skip check

Harder: Alternate-leg bounding

3D demoPogo hopsIntermediate · No equipment

2 sets of 10 to 20 · The leaflet's jump check

Easier: Ankle bounces (mini pogo) · Harder: Single-leg pogo hops

Treadmill jogging demonstrated on the 3D figure

3D demoTreadmill joggingIntermediate · Cardio machine

Gentle running, then training · Walking, swimming and cycling first, then gentle running: the leaflet's order

Easier: Treadmill walking · Harder: Sprint intervals

Move on when: Full training stays at 3 out of 10 or less and settles soon after. If the pain comes back with a growth spurt, go back to stage 1 for a while.

Follow along: a timer, a cue and the next move, one step at a time.

What to change for now

Heel cups, shoes and ice

Gel heel cups, heel cushions or shock-absorbing insoles, in supportive, cushioned trainers, are cheap and widely recommended. Avoid barefoot running, jumping and gymnastics while it's sore. Ice wrapped in a towel for 10 to 15 minutes after sport may ease it; NHS Lothian also suggests a heat pack, checking the skin regularly.

Sources 2, 1, 3, 13

A smaller role, not no role

NHS Lothian's leaflet says it's important to stay involved with teams and clubs: if running and jumping are too sore, find a role your child can do while it settles, and tell the coach that activities may need adapting for a while.

Source 13

Planning the week

The same leaflet's guide is no more than 4 high-intensity sessions a week, not on 2 days in a row, and total hours of structured sport a week no more than your child's age, with good sleep and rest days to recover. It notes that Sever's disease is more common in athletes who specialise early in one sport.

Source 13

Positions to swap, and why

Habit or position	Why it matters	Instead
Stopping all sport	There's no evidence it's needed, and sport is unlikely to cause lasting damage.	Cut back running and jumping, and keep playing within 3 out of 10.
Playing through pain above 3 out of 10	That's above the NHS leaflet's limit.	A smaller role in the team for a while.
Barefoot running, jumping or gymnastics	It can make the heel sorer.	Cushioned trainers and heel cups.
Hard sessions on consecutive days, or more weekly hours of organised sport than your child's age	These are above the NHS leaflet's limits, which give the body time to recover.	No more than 4 high-intensity sessions a week, with rest days between.
Calf stretches while the heel is sore	Children's physiotherapists advise stretching when it isn't sore.	Stretch after school or on a rest day.
Buying expensive orthotics or new trainers to fix it	In a trial, a simple heel raise did as well as ready-made orthoses, and new shoes made no difference.	Inexpensive gel heel cups.

Routines to follow

Animal moves for kids: a 15-minute active play workout

Fifteen minutes of animal moves, jumps and balance games for children, building the muscle- and bone-strengthening activity they need, with nothing to buy.

15 minBeginner16 movesA wall

Foot and ankle strengthening routine: toes, arches, calves and balance

A 15-minute barefoot routine for stronger toes, arches, calves and ankles, finishing with balance. You need only a towel, a wall and a resistance band.

15 minBeginner11 movesA wall, Other / check instructions

More moves for this area

Questions people ask

What is Sever's disease?

Pain where the Achilles tendon pulls on the growth area at the back of the heel, in active children aged about 8 to 15. Despite the name, it's a common overuse injury, not an illness, and it goes once the heel finishes growing.

Can my child keep playing sport?

Usually, yes. Sport is unlikely to cause lasting damage. Cut back the running and jumping so pain stays at 3 out of 10 or less, and consider a full break only if the pain stays severe.

How long does Sever's disease last?

Often a few months, but sometimes 12 to 24 months, and it can come back with a growth spurt. It stops once the heel's growth area fuses, which starts at about 12 and is finished in most children by the mid-teens.

Do heel cups or insoles help?

Many children find them helpful, and very active boys had less pain during sport with them in one study. In a trial, a heel raise did slightly better than a ready-made orthosis at 1 to 2 months, but by a year there was no difference, and new shoes didn't help.

Which stretches help Sever's disease?

Calf stretches with the knee straight and bent, held for at least 30 seconds, three times, every day. They're low-risk and widely advised, though no trial has shown that they speed recovery on their own.

Does my child need an X-ray?

Usually not, as it's diagnosed from the story and a heel squeeze. A doctor may want one if the pain doesn't fit, for example pain at night, swelling, a fever or a recent injury.

Is it growing pains?

No. Growing pains ache in both legs in the evening or at night and are gone by the morning. Sever's pain is in the heel and comes with sport.

When should we see a GP?

Once, to confirm it's Sever's disease. After that, if the pain isn't linked to activity, is there at night or first thing in the morning, comes with swelling, redness or a fever, causes a limp away from sport, or hasn't improved after 6 weeks of the advice.

Will it cause problems when my child is older?

It isn't expected to. A children's hospital fact sheet and NHS leaflets say children recover completely, with no long-term problems, once the heel finishes growing.

How do we know when they can go back to full training?

When they can hop, skip and jump quietly without pain. Then add one session a week, keep high-intensity sessions to no more than 4 a week, and keep weekly hours of organised sport to no more than their age.

Related exercise guides

Other pain guides

Sources

Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.