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Apophysitis is a painful inflammation of the heel’s growth plate. It typically affects children between the ages of 8 and 14 years old, because the heel bone (calcaneus) is not fully developed until at least age 14. Until then, new bone is forming at the growth plate (physis), a weak area located at the back of the heel. When there is too much repetitive stress on the growth plate, inflammation can develop. Calcaneal apophysitis is also called Sever’s disease or Sever’s syndrome, although it is not a true “disease.” This Severs condition is the most common cause of heel pain in children, and can occur in one or both feet.

Heel pain in children differs from the most common type of heel pain experienced by adults. While heel pain in adults usually subsides after a period of walking, pediatric heel pain generally doesn’t improve in this manner. In fact, walking typically makes the pain worse.


Apophysitis is an overuse injury that typically occurs after repetitive activities of the muscles attached to the apophysis. Adolescents with excessively tight hip and thigh muscles are more prone to pelvis/hip apophysitis. The apophyses most commonly affected are the anterior superior iliac spine (ASIS), the anterior inferior iliac spine (AIIS) and the iliac crest. The muscles that attach to these apophyses flex the hip and rotate and twist the pelvis and trunk. Apophysitis of the pelvis/hip usually affects runners, sprinters, dancers, soccer players, and ice hockey players.

Symptoms of Severs Apophysitis

Symptoms of calcaneal apophysitis may include:

  • Pain in the back or bottom of the heel
  • Limping
  • Walking on toes
  • Difficulty running, jumping, or participating in usual activities or sports
  • Pain when the sides of the heel are squeezed


To diagnose the cause of the child’s heel pain and rule out other more serious conditions, the foot and ankle surgeon obtains a thorough medical history and asks questions about recent activities. The surgeon will also examine the child’s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.

Authored By : DR. DAVID V RAJAN

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