Is Your Young Runner Complaining of Heel Pain? It Could Be Sever's Disease.

As summer training ramps up and young runners begin preparing for cross country season, one of the most common injuries we see is Sever’s disease, also known as calcaneal apophysitis. While the name sounds alarming, Sever’s disease is not actually a disease. Instead, it is an overuse injury involving the growth plate at the back of the heel.

At True 2 Form in Schoolcraft, Michigan, we see this condition every year as athletes increase their mileage, participate in summer conditioning, and transition into the demands of the cross country season. The good news is that, with early intervention and the right treatment approach, most young athletes recover quickly and return to running pain-free.

What Is Sever’s Disease?

The heel bone (calcaneus) has a growth plate where new bone develops during childhood and adolescence. Until this growth plate closes—typically between ages 13 and 15 in girls and 15 to 17 in boys—it remains more vulnerable to stress.

Every time a runner lands, the Achilles tendon pulls on the back of the heel while ground reaction forces push upward from below. During periods of rapid growth, the bones often lengthen faster than the muscles and tendons can adapt. The result is increased tension across the heel’s growth plate, leading to irritation and inflammation.

This condition is called calcaneal apophysitis, or Sever’s disease.

Why Is It So Common During Cross Country Season?

Late summer is the perfect storm for this injury.

Many young athletes suddenly increase:

• Weekly running mileage
• Running frequency
• Speed workouts
• Hill training
• Plyometric exercises
• Time spent in worn-out running shoes

After a relatively quieter spring or early summer, the heel is suddenly exposed to much higher repetitive loads. Without adequate adaptation, the growth plate becomes irritated.

Children between 8 and 15 years old are particularly susceptible because they are often in the middle of rapid growth while simultaneously becoming more competitive in sports.

Signs and Symptoms

Young runners with Sever’s disease commonly report:

• Pain at the back or bottom of the heel
• Pain that worsens during or after running
• Limping after practice
• Morning stiffness
• Tenderness when the sides of the heel are squeezed
• Improvement with rest but recurrence once running resumes

Many parents initially think their child simply has a bruise or needs new shoes. However, persistent heel pain should never be ignored in a growing athlete.

Why Rest Alone Often Isn’t Enough

Traditional treatment has often focused on reducing activity until symptoms improve.

While temporary reduction in training may calm symptoms, it doesn’t address the underlying issues that caused excessive stress on the heel in the first place.

Successful treatment should also focus on:

• Improving calf flexibility
• Restoring foot strength
• Improving ankle mobility
• Addressing running mechanics
• Managing training loads
• Improving force absorption throughout the lower extremity

When these factors are corrected, young athletes are much less likely to experience recurring heel pain.

Shockwave Therapy: A Modern Approach

At True 2 Form in Schoolcraft, we utilize Cellwave, or Extracorporeal Shockwave Therapy (ESWT), as part of a comprehensive treatment program for many cases of Sever’s disease.

Cellwave therapy delivers controlled acoustic waves into injured tissue, stimulating the body’s natural healing response. It can help:

• Reduce pain
• Improve local blood flow
• Stimulate tissue healing
• Accelerate recovery
• Allow athletes to return to activity sooner when combined with proper rehabilitation

Unlike injections or medications, shockwave therapy is non-invasive and requires no downtime. For many young athletes, it becomes an excellent option when heel pain has persisted despite rest, stretching, or shoe modifications.

Every athlete receives an individualized evaluation to determine whether shockwave therapy is appropriate as part of their treatment plan.

Preventing Sever’s Disease

Although no injury is completely preventable, reducing stress on the heel can dramatically lower the risk.

1. Strengthen the Intrinsic Foot Muscles

Strong feet absorb impact more efficiently.

Try these exercises:

• Short Foot Exercise
• Toe yoga
• Towel curls
• Barefoot balance drills
• Single-leg balance on unstable surfaces

2. Improve Calf Flexibility

Tight calves increase pulling forces on the heel.

Perform:

• Gastrocnemius stretches (knee straight)
• Soleus stretches (knee bent)
• Foam rolling of the calves

Stretch consistently after activity rather than aggressively before running.

3. Build Calf Strength

Strong calf muscles better tolerate repetitive loading.

Include:

• Double-leg calf raises
• Single-leg calf raises
• Slow eccentric heel lowering
• Jump rope progression (only if pain-free)

4. Don’t Increase Mileage Too Quickly

One of the biggest mistakes young runners make is increasing weekly mileage too rapidly.

Gradually build volume and intensity over several weeks rather than making large jumps.

5. Replace Worn Running Shoes

Running shoes gradually lose their cushioning and ability to absorb impact.

Parents should monitor shoe wear throughout the season and replace shoes before excessive breakdown occurs.

6. Stay Barefoot—At the Right Times

Appropriate barefoot activity on safe surfaces can help strengthen the small intrinsic muscles of the feet that provide stability and improve shock absorption. Activities such as walking barefoot on grass, balance exercises, or simple foot-strengthening drills can be valuable additions to a young runner’s routine. The key is to progress gradually rather than making sudden increases in barefoot activity.

When Should You Seek Treatment?

If your child has heel pain that:

• Lasts more than one to two weeks
• Causes limping
• Limits running or other sports
• Returns every time activity increases

it’s time for a professional evaluation.

Early treatment often means a shorter recovery and less time away from the sports they love.

Helping Young Athletes Stay Healthy

At True 2 Form in Schoolcraft, we specialize in combining sports medicine, biomechanics, and performance science to identify why an injury developed—not simply where it hurts.

For young runners with Sever’s disease, that means evaluating foot mechanics, strength, flexibility, training habits, and movement patterns while utilizing evidence-based treatments such as shockwave therapy when appropriate.

The goal isn’t simply getting athletes out of pain—it’s helping them develop stronger, more resilient feet so they can enjoy a healthy cross country season and continue doing what they love.

 

Schedule an appointment or contact us if you have questions and Dr. Deming will reply to you directly!