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Sever’s Disease in Singapore: Children’s Heel Pain

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Written & reviewed by the BestDoctors.sg editorial team · Last updated 24 Aug 2026 · General information, not medical advice

Sever’s disease (calcaneal apophysitis) is one of the most common causes of heel pain in active, growing children and young teenagers. It is not an infection but irritation of the growth plate at the back of the heel bone, where the Achilles tendon repeatedly pulls during running and jumping. It is self-limiting: once the growth plate finishes maturing, usually by the mid-teens, it resolves completely and causes no long-term damage or arthritis. Simple measures ease the pain while the child grows.

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In a medical emergency, or for severe or sudden symptoms such as breathing difficulty, chest pain, fainting or stroke signs, call 995 immediately.

Heel pain with fever, marked swelling and redness, night or rest pain, an inability to walk, or pain after a specific injury is not typical of Sever’s and needs a doctor to exclude other causes.

Why it happens

In children the heel bone is still growing from a soft growth plate at the back, and the calf tendon attaches nearby. Repetitive traction and impact from running and jumping irritate the still-developing plate, causing pain. It often coincides with a growth spurt, when bones can temporarily grow faster than the muscles and tendons, increasing tightness and pull on the heel. It commonly affects both heels and typically flares during or after sport.

Common causes and who it affects

It usually occurs around the growth-spurt years — roughly ages 8 to 15 in boys and 7 to 12 in girls, though ages are approximate. Running- and jumping-heavy sports such as football, basketball, gymnastics, athletics and dance are common triggers, along with growth spurts, tight calf muscles, flat or high-arched feet, unsupportive or worn-out shoes, walking barefoot on hard surfaces, higher body weight, and sudden increases in training.

Symptoms

The main symptom is pain at the back or bottom of one or both heels, usually worse during and after activity and eased by rest, with tenderness when the sides of the heel are squeezed. A child may limp, walk on tiptoe or be reluctant to bear full weight after sport, and may have morning stiffness. Rising on tiptoe often reproduces the pain. Importantly, the heel usually looks normal, with little or no swelling, redness or bruising.

Red flags

Some features point away from simple growth-plate irritation and need review to exclude infection, inflammatory arthritis, a fracture or other causes: heel pain with fever, or with warmth, marked swelling and redness; night pain or pain at rest that wakes the child, or pain unrelated to activity; pain that is constant, steadily worsening or unresponsive to several weeks of simple measures; an inability to bear weight or severe pain after a fall; or a swollen joint, rash, weight loss or feeling generally unwell. Most Sever’s cases are not emergencies, but a sudden severe problem warrants urgent care via 995.

How it is assessed and treated

Sever’s is usually a clinical diagnosis from the history and examination — heel-squeeze tenderness, tight calves and pain on tiptoe. X-rays are generally not needed to confirm it, because the growth plate can look the same in children with and without symptoms; imaging is used mainly to exclude other causes when the picture is atypical or red flags are present. A family doctor or paediatrician often manages it first, with a sports physician, physiotherapist or podiatrist guiding rehabilitation. Treatment centres on reassurance that the condition is benign and settles with growth. Activity is modified rather than stopped entirely — reducing or pausing the aggravating high-impact sport until pain settles, then gradually returning within comfortable limits. Ice after activity, calf and hamstring stretching, and cushioned heel cups, gel pads or supportive footwear all help, along with simple pain relief as advised. Steroid injections and surgery are not appropriate for Sever’s. Symptoms typically improve over weeks to a few months, though flares can recur with growth or heavy sport until the growth plate matures.

Helping your child through a flare

A few simple habits help a child through a Sever’s flare and reduce how often it comes back. Cushioned heel cups or gel pads worn in both shoes soften the impact on the growing heel, and a short daily routine of calf and hamstring stretches eases the pull of the tendon on the growth plate — especially useful during growth spurts, when muscles tighten as bones lengthen. Make sure sports shoes are supportive and not worn out, limit long stretches of barefoot walking on hard floors, and ice the heel after sport. Pacing matters more than stopping: rather than banning sport, help your child stay active within comfortable limits and ease off high-impact activity during a bad patch, building back gradually as the pain settles. It reassures children to know the problem is temporary, does no lasting harm, and will resolve as they finish growing. If pain keeps forcing a limp or is not settling, a doctor, physiotherapist or podiatrist can guide a stretching and footwear plan.

When to see a doctor

See a doctor if heel pain persists beyond a couple of weeks of rest and simple measures, keeps recurring, or limits sport or school, or if the child limps, walks on tiptoe or cannot put weight through the heel. Seek prompt care for any red flag such as fever, a red or swollen heel, night pain, or feeling unwell.

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Sources

General information only. This guide is general information about a foot or ankle condition and is not a diagnosis or personalised medical advice. See a doctor, podiatrist or foot-and-ankle specialist for assessment and treatment. If you have diabetes or poor circulation, do not treat foot problems (corns, calluses or nails) yourself with blades or acid removers — have them checked professionally, and seek prompt care for any non-healing sore, ulcer, spreading redness, or a hot, swollen, painful foot with fever (possible infection). Sudden severe swelling or an inability to bear weight after an injury needs urgent assessment.

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Frequently asked questions

Will my child grow out of Sever’s disease?

Yes. It is self-limiting and almost always resolves once the heel growth plate finishes maturing, usually by the mid-teens. It does not cause arthritis or long-term damage.

Does my child need to stop all sport?

Usually not completely. Most children reduce high-impact activity during flares and stay active within comfortable limits, then gradually build back up. Pain that forces a limp is a sign to ease off.

Does my child need an X-ray or scan?

Often not. Sever’s is usually diagnosed from the examination. Imaging is mainly ordered to rule out other problems if the pain is one-sided, severe, present at night or rest, or associated with swelling, redness or fever.

Do heel cups or special insoles help?

Many children get relief from gel heel cups, cushioned insoles and supportive shoes, which reduce impact on the heel. They are simple, low-risk measures; a podiatrist or doctor can advise if custom orthoses are worthwhile.

When should I worry it is something more serious?

Seek review if there is fever, a red, hot or swollen heel, pain at night or at rest, pain unrelated to activity, an inability to walk, or if your child seems generally unwell. These are not typical of Sever’s and need a doctor to check for other causes.