Sever’s disease (aka calcaneal apophysitis) is a common cause of heel pain in growing children, especially those who are physically active (ages 8–14). It results from inflammation at the growth plate (apophysis) of the heel bone (calcaneus) due to repetitive stress. If the pain is at the back of the heel, activity-related, in a skeletally immature child, and improves with rest and the pain can be reproduced by squeezing the heel, then it is mist likely Sever’s disease. But red flags like fever, rest pain, systemic symptoms, or trauma should trigger further workup.
While these other causes are uncommon, they do need to be ruled out as part of the assessment process:
Plantar Fasciitis
Achilles Tendinopathy / Tendinitis
Retrocalcaneal Bursitis
Calcaneal Stress Fracture
Heel Pad Contusion (“Stone Bruise”)
Tarsal Coalition
Juvenile Idiopathic Arthritis (JIA)
Reactive Arthritis
Calcaneal Osteomyelitis
Septic Arthritis (of subtalar or ankle joint)
Sural or Tibial Nerve Entrapment
Bone tumour
Psychogenic Pain / Non-Organic
While most of these conditions are rare, they can be potentially quite serious, hence the importance of getting a diagnosis right first.
