The Saturday-morning conversation every footy parent eventually has
It usually goes like this. Your 11-year-old comes off the ground at half time and says his heel is sore. You watch the second half. He’s slower, he favours the other leg, and he limps off the field. By Monday morning he’s tip-toeing down the hallway. By Tuesday he says he’s fine, by Wednesday training he’s limping again, and by Saturday the cycle restarts.
You take him to the GP. The GP says it’s growing pains and to rest. You rest him for a week. He goes back to training. The pain comes back inside one session. You go to a second GP. You get told it might be Achilles tendinitis and to try anti-inflammatories. Nothing changes. Now it’s six weeks in, the season is half-over, and your child is asking you whether something is wrong with him.
This is almost always Sever’s disease. It is the single most common cause of heel pain in active Australian kids. It is well understood. And it is manageable — not by stopping sport altogether, but by changing how the heel is loaded for a while, until your child grows out of it.
It is also extremely common. Sever’s accounts for somewhere between two and sixteen per cent of paediatric musculoskeletal presentations, depending on which study you read and which population you sample (Smeed et al., Cureus 2025). The German youth soccer academy that audited ten years of their injury records found about one in every three hundred academy players carrying it in any given year, and bilateral cases — both heels at once — were the ones that took longest to settle (Belikan et al., J Orthop Surg Res 2022). Junior AFL, Auskick, junior NRL, junior rugby, basketball, netball, soccer and gymnastics all see it regularly across the 8–14 bracket. The point is not that your child is unusual. The point is that thousands of parents are having the same Saturday-morning conversation right now, and the management is the same for all of them.
This article is the version of the explanation we wish more families got at the start of all this. If you are reading it three weeks in, you are not late. If you are reading it on a Saturday afternoon after a tough game, you are not alone.
What Sever’s actually is
The heel bone in a child is not yet one solid piece. There is a growth zone at the back of the heel — called the calcaneal apophysis — where new bone is being laid down. This zone is “open” and active from roughly age seven until somewhere between 13 and 17, depending on the child. Until it closes, this growth zone is mechanically softer than the surrounding heel bone.
The Achilles tendon — the big rope at the back of the ankle — attaches directly onto this growth zone. Every time your child runs, jumps, sprints or kicks, the calf muscles pull on the Achilles tendon, which pulls on the growth zone. In an adult, that force lands on solid bone. In a 10-year-old, it lands on a growth plate that hasn’t finished forming yet.
When your child plays a lot of sport — particularly running and jumping sports on hard ground — those repeated pulls add up. The growth zone gets sore. That soreness is Sever’s disease.
A few things follow from this that are worth holding on to:
It is not an injury in the usual sense. Nothing is torn. Nothing is broken. The growth zone is just being asked to handle more load than it currently can.
It does not cause long-term damage. There is no evidence that kids who had Sever’s grow up with worse heels, slower running, or any other long-term problem.
It will end on its own. When the growth zone finishes ossifying — somewhere between 13 and 15 for boys, often a little earlier for girls — there is no more growth zone to be irritated. The condition simply stops happening. This is what doctors mean when they say it is “self-limiting.”
This is important because it frames what we are doing for the next few weeks or months. We are not trying to fix something permanent. We are managing a temporary mismatch between how much sport your child wants to play and how much load the growth zone can currently absorb.
Why it happens at this age
Three things conspire around age 10 to 14.
The first is growth. The bones in a child’s leg grow before the muscles and tendons stretch to match. For a period — usually six to twelve months around the biggest growth spurt — the calf and the Achilles are functionally “tight” because they haven’t caught up. That tightness pulls harder on the growth zone every time your child runs.
The second is sport. Junior footy, soccer, basketball, netball and athletics involve a lot of running, jumping and changing direction. Footy boots in particular have a very low heel, which puts the Achilles on more stretch with every step than a runner does. Hard ground at the start of the season makes this worse.
The third is the growth plate itself. It is softer than mature bone, and it is the structural weak link in the chain that goes calf muscle — Achilles tendon — heel bone. When loads get high enough to start hurting something, the growth plate is what hurts.
The combination is why we see this most often at the start of a season, in a child who has had a growth spurt over summer, who is back into training volume after a break, in a sport that’s hard on the heel. As Essendon Sports Medicine’s team has written in their parent guide on this exact pattern: “Sever’s flares up at the start of footy season because there is a sudden spike in activity after a quiet off-season, poorly fitted boots, hard playing surfaces, and growth spurts all happening at once” (Essendon Sports Medicine, 2025).
What not to do
A few things are still done routinely that the evidence does not support.
Pulling your child out of sport completely. This is the single most common over-reaction, and it does more harm than good. Wiegerinck and colleagues’ randomised trial of 100 children with Sever’s compared a “wait and see” approach (keep playing, modulate by symptoms) against heel raises against formal physiotherapy. All three groups improved. None was clearly better than the others (Wiegerinck et al., J Pediatr Orthop 2016). The James systematic review of nine treatment studies reached the same conclusion the year before (James, Williams & Haines, J Foot Ankle Res 2013).
This matters because complete sporting withdrawal is not neutral. Three months out of an under-12s squad is, in practice, often the end of that season and sometimes the end of that sport. The Australian Sports Commission’s position on youth sport explicitly identifies extended forced absence as a major driver of long-term sporting disengagement. Kids who get told their heel pain means they can’t play do not always come back.
Cortisone injections. Not appropriate at a growth plate in a 10-year-old. This should not be on the table.
Long-term anti-inflammatories. Short bursts for symptom flare-ups are fine. Anything beyond a few days is overkill for a condition that will resolve on its own.
Worrying about long-term damage. Sever’s does not leave any lasting mark on the foot. The Royal Children’s Hospital Melbourne fact sheet — produced by their orthopaedic department — is unambiguous on this: “Sever’s disease will resolve itself without treatment, and rarely causes long-term problems” (RCH Melbourne; Better Health Channel, 2021).
What to do
The active ingredient is load management. The principle is: keep your child playing the sport they love, but at a volume the heel can tolerate, until the growth zone settles or finishes ossifying.
Reduce training volume, don’t eliminate it. If two training sessions and a game a week make the heel hurt, drop to one training and a game. If that still hurts, drop to half a game. Find the level where the heel is sore during activity (up to about a 4 out of 10) but settles by the next morning. Hold there for two or three weeks. Then re-introduce volume gradually.
Heel raises in the shoe. A small wedge under the heel — around six to nine millimetres — shortens the working position of the calf and the Achilles, which reduces the pull on the growth zone with each step. Plain foam heel cups from a pharmacy work. So do podiatry-fitted versions. The trial evidence suggests the type matters less than the principle of offloading.
Ice after activity. Twenty minutes after a game or training, on the painful spot. This is for comfort, not cure — it doesn’t change what’s happening in the growth plate, but it makes the next morning easier.
Calf flexibility and strength work. A simple wall calf stretch twice a day, and bent-knee and straight-knee calf raises three times a week, is a reasonable home programme. A physio can build this out properly if the symptoms last more than a couple of weeks.
Footwear review. Particularly the football boots. Modern junior boots have very little heel drop, which puts the calf and the Achilles on more stretch with each step than your child is used to. A small in-shoe heel raise inside the boot fixes most of this.
Physio assessment if symptoms persist beyond two weeks of load modification. A paediatric or sports physio can assess the calf, the foot mechanics, and the training-load history, and build a calibrated return-to-play programme. The team at the Better Health Channel (a Victorian government health resource produced with the Australian Physiotherapy Association) recommends this as standard if symptoms persist (Better Health Channel, 2021).
The calf-and-Achilles angle, in plain English
The reason a heel raise works, and the reason calf conditioning works, is the same reason any of this matters. The pain is being generated by tension. The calf muscles pull the Achilles tendon. The Achilles tendon pulls on the heel bone’s growth plate. Reduce that pull, and you reduce the pain at source.
This is also why the soleus — the deeper calf muscle, the one that does most of the work during walking and slow running — gets specific attention in modern physio programmes. A standard straight-knee calf raise targets the gastrocnemius, the surface calf muscle. A bent-knee calf raise targets the soleus. Both are needed. Most home programmes skip the bent-knee version, which is part of why some kids stay symptomatic longer than they should.
The Sleeve, and where it fits in a parent’s kit
Most of what you do for Sever’s happens in the gaps between training sessions — the in-shoe heel raise, the calf stretches, the ice after a game, the conversation with the coach about cutting one run-through out of the warm-up. The harder question is what to do about the load that the heel takes during ordinary life. Your child still walks to school. Still runs around at recess. Still kicks the footy in the backyard. Each of those is a small heel-traction event, and they add up across a week in a way that can quietly hold the symptoms there.
The Orthopaedic Sleeve is a daily-wear option that sits in that gap. It is a lower-leg sleeve, originally developed for adult athletes with Achilles tendon problems, and the mechanism it uses is the same lever that matters in Sever’s: it reduces the amount of work the calf muscles do during movement, which means less tension travels down the Achilles to where it pulls on the heel.
The number that matters most for a child with Sever’s is the Achilles tendon force reduction. The University of Queensland’s independent testing of the device (Final Report, June 2025) showed an 8.1% reduction in peak Achilles tendon force during walking in the best-responding individuals. That force is the traction force on the growth plate. Eight per cent less of it, with every step, every day, is meaningful when you’re trying to hold the dose of irritation below the level the heel can handle. The same testing showed a 5% reduction in how long the heel is in contact with the ground per step, which slightly softens the impact load the calcaneus takes per footfall.
For the parent who doesn’t want to pull their kid out of footy entirely but needs to take the daily background load off the heel, the Sleeve is one of the tools available. Frame it as a load-modifier that works at the source — the Achilles pull on the growth zone — rather than as a brace that immobilises the foot.
Honest framing: the device is primarily designed for adult athletes, and the trial work to date has been done in adults. The mechanism translates to children with Sever’s because the pathway is the same — calf contraction, Achilles tension, force at the heel — but the trial evidence in children specifically does not yet exist. Sizing for a younger or smaller leg should be verified with a sports physio or podiatrist before purchase. The Sleeve sits alongside the in-shoe heel raise, the calf-conditioning programme, and the training-load conversation. It is part of the kit, not the whole of it. But for a parent looking for a way to reduce the daily ambient load on a sore heel without turning their child’s life upside down, it does the specific job of cutting the Achilles pull at source.
When to see a doctor
For most kids with Sever’s, you do not need imaging, you do not need a specialist, and the GP-or-physio pathway works fine. The exceptions:
Pain that wakes the child at night, with no obvious activity cause.
Visible swelling or redness around the heel.
Refusal to bear weight on the leg at all.
A history of recent injury rather than a gradual onset over weeks.
Fever, weight loss, or other systemic symptoms.
These would not be normal Sever’s and warrant a more careful workup. None of them are common, but they are the features that earn imaging and bloodwork rather than reassurance.
What to expect
Most kids with Sever’s are doing better within four to twelve weeks of starting load modification. Some will flare again a few months later, particularly around another growth spurt or a change of sporting season. That is not failure; it is the condition’s natural behaviour while the growth plate is still open.
Once your child reaches skeletal maturity — usually 13 to 15 for boys, slightly earlier for girls — the condition stops. Permanently. There is no recurrence in adulthood.
The job between now and then is not to fix something irreversible. It is to keep your child engaged with their sport, manage the load, and ride out the period until the heel finishes growing. The 11-year-old who limps off the ground in round 6 of his under-12 season can, with thoughtful management, be playing through the back half of the season at modified volume, finishing on his feet, and back to full training before the next pre-season. That is the realistic expectation. Plan towards it.
References and further reading
Better Health Channel (Victoria Department of Health, in consultation with the Australian Physiotherapy Association). Sever’s disease. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/severs-disease
Essendon Sports Medicine. Heel Pain in Young Athletes: What Parents Need to Know About Sever’s Disease (June 2025). https://www.essendonsportsmedicine.com.au/about/blog/heel-pain-in-young-athletes-what-parents-need-to-know-about-severs-disease
Royal Children’s Hospital Melbourne, Orthopaedic Department. Sever’s disease fact sheet. https://www.rch.org.au/uploadedFiles/Main/Content/ortho/factsheets/SEVERS-DISEASE.pdf
James AM, Williams CM, Haines TP. Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever’s disease): a systematic review. Journal of Foot and Ankle Research. 2013;6:16.
Wiegerinck JI, Zwiers R, et al. Treatment of calcaneal apophysitis: wait and see versus orthotic device versus physical therapy. Journal of Pediatric Orthopaedics. 2016;36(2):152–157.
Belikan P, Färber LC, Abel F, et al. Incidence of calcaneal apophysitis (Sever’s disease) and return-to-play in adolescent athletes of a German youth soccer academy: a retrospective study of 10 years. Journal of Orthopaedic Surgery and Research. 2022;17:83.
Smeed J, et al. Conservative Management of Sever’s Disease (Calcaneal Apophysitis): A Comprehensive Review of Treatment Efficacy. Cureus. 2025.
University of Queensland, School of Mechanical and Mining Engineering. The Orthopaedic Sleeve: Biomechanical Assessment — Final Report. June 2025.