Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer: Sever’s disease (calcaneal apophysitis) is the most common cause of heel pain in children aged 8-14 years. It results from traction stress on the calcaneal growth plate during rapid growth phases. It’s treated with heel lifts, activity modification, stretching, and orthotics — and always resolves when growth stops. It is not dangerous and does not cause permanent damage.
What Is Sever’s Disease?
Sever’s disease — more accurately called calcaneal apophysitis — is inflammation of the growth plate (apophysis) at the back of the heel bone in growing children. During rapid growth spurts, the Achilles tendon and plantar fascia pull on the relatively soft cartilaginous growth plate, causing inflammation and pain. It most commonly affects active children aged 8-14 (girls slightly earlier due to earlier growth spurts), particularly those involved in running sports, soccer, basketball, and gymnastics. The growth plate closes around age 14-16, at which point Sever’s disease always resolves permanently.
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Symptoms and Recognition
Classic Sever’s disease presentation: activity-related heel pain in a growing child (especially during or after sports), pain at the back or bottom of the heel (different from plantar fasciitis location), tenderness with the ‘squeeze test’ (compressing the sides of the heel), pain worse during growth spurts and high-activity seasons, and improvement with rest. Bilateral symptoms are common. Unlike plantar fasciitis, Sever’s disease pain is typically worst during and after activity rather than on first morning steps.
Treatment: Effective and Straightforward
Sever’s disease responds well to conservative management: heel lifts or heel cushions in athletic footwear (reduce Achilles traction on the apophysis), activity modification (reduce but don’t completely eliminate activity), calf and Achilles stretching (tight calves increase traction force), supportive athletic footwear, ice after activity (10-15 minutes), NSAIDs for pain flares (with parental guidance). In severe cases, a walking boot for 2-4 weeks allows the inflammation to settle. Orthotics with heel cushion help for children with flat feet contributing to the condition.
Reassuring Parents
Sever’s disease is not dangerous and causes no permanent damage to the heel or growth plate. It will always resolve when the growth plate closes, typically around age 14-16. While it can limit athletic participation during growth spurts, it does not affect long-term foot function. The condition often recurs seasonally (beginning of soccer or basketball season during growth spurts) until growth stops.
Dr. Tom's Product Recommendations
PowerStep Pinnacle Orthotic
⭐ Highly Rated | Foundation Wellness Partner | 30% Commission
Podiatrist-recommended insoles in youth sizes with heel cup and arch support. Reduces Achilles traction on the growth plate in Sever’s disease. Fits most athletic shoes.
Dr. Tom says: “https://m.media-amazon.com/images/I/71k+PB6ZHLL._AC_SL300_.jpg”
Sever’s disease in children 8-14, heel pain with activity, growing pains in active kids
Children under age 5 or with rigid flat feet requiring specialist evaluation
Disclosure: We earn a commission at no extra cost to you.
Doctor Hoy’s Natural Pain Relief Gel
⭐ Highly Rated | Foundation Wellness Partner | 30% Commission
Natural arnica-based topical gel appropriate for children’s post-activity heel soreness. Non-NSAID alternative for topical pain management in Sever’s disease.
Dr. Tom says: “https://m.media-amazon.com/images/I/71Z5e1QKXUL._AC_SL300_.jpg”
Sever’s disease post-activity heel pain in children, topical adjunct therapy
Open skin, active infection, or rash — intact skin application only
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Sever’s disease always resolves when growth stops — it is not a permanent condition
- Treatment is straightforward: heel lifts, stretching, and activity modification
- Parents can be completely reassured — no long-term damage occurs
❌ Cons / Risks
- Symptoms can be severe enough to limit sports participation during growth spurts
- Recurrence at the start of each sports season is common until growth plate closure
- Differential diagnosis requires evaluation to rule out stress fracture, plantar fasciitis, and other conditions
Dr. Tom Biernacki’s Recommendation
Sever’s disease is a diagnosis I love giving because I get to completely reassure a worried parent and a frustrated athlete in the same conversation. The parent is relieved the child doesn’t have a fracture or serious injury. The athlete gets a clear explanation for why their heel hurts and what to do about it. And both of them get the reassurance that this will go away permanently when they finish growing. A heel lift, some stretching, and a little activity modification — and most kids are back to sports within a few weeks.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
Is Sever’s disease serious?
No — Sever’s disease is a benign, self-limiting condition that causes no permanent damage. It will always resolve when the growth plate closes. While the pain can be significant and limit sports activity, parents and athletes can be reassured that there is no long-term risk to foot function.
Should children with Sever’s disease stop playing sports?
Complete sports cessation is rarely necessary. Activity modification — reducing intensity and duration during flares, using heel lifts, ensuring proper footwear — allows most children to continue participating at a comfortable level. Only severe cases with intolerable pain warrant temporary sport withdrawal, typically for 2-4 weeks in a boot.
Why does my child’s heel hurt on both sides?
Bilateral heel pain is very common in Sever’s disease because the growth plate closure timing and Achilles tension affects both heels simultaneously during growth spurts. Bilateral symptoms actually help confirm the Sever’s diagnosis — asymmetric or severe unilateral symptoms should prompt X-ray evaluation to rule out other pathology.
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📞 (810) 206-1402 Book Online →When Shoes Aren’t Enough — Dr. Tom’s Top 9 Orthotics
About 30% of patients I see for foot pain need MORE than a great shoe — they need a structured insole. Below: my complete 2026 orthotic ranking with pros, cons, and the specific patient I’d give each one to.
★ DR. TOM’S COMPLETE 2026 ORTHOTIC RANKING
9 Best Prefab Orthotics by Use Case
PowerStep, Currex, Spenco, Vionic, and PowerStep Pinnacle — every orthotic I’ve fitted to thousands of patients across both Michigan offices. Each card includes pros, cons, and the specific patient I’d give it to. Real Amazon ratings, review counts, and prices below.
Best All-Purpose Orthotic for Most Patients
Semi-rigid arch shell + dual-layer cushion + deep heel cup. The orthotic I’ve fitted to more patients than any other for 15 years. APMA-accepted. Trim-to-fit design works in athletic shoes, casual shoes, and most work boots.
✓ Pros
- Semi-rigid arch shell provides true biomechanical correction
- Deep heel cup centers the heel and reduces lateral instability
- Dual-layer cushion (top + bottom) lasts 9-12 months daily wear
- Available in 8 sizes for precise fit
- APMA-accepted and clinically validated
- Lower price than PowerStep Pinnacle for equivalent function
✗ Cons
- Too thick for most dress shoes (use ProTech Slim instead)
- Some break-in period required (3-7 days for arch tolerance)
- Not enough correction for severe pes planus or rigid pes cavus
Dr. Tom’s Recommendation: If a patient has run-of-the-mill plantar fasciitis, mild flat feet, or arch fatigue, this is the first orthotic I try. Better value than PowerStep Pinnacle for 90% of patients, which is why I swapped it into our clinic kits three years ago. Sub-$50 typically.
Maximum Motion Control · Flat Feet & Severe Over-Pronation
PowerStep’s most aggressive stability orthotic. Adds a 2°-7° medial heel post on top of the standard PowerStep platform — designed specifically for flat-footed patients and severe pronators who need real corrective force.
✓ Pros
- 2°-7° medial heel post adds aggressive pronation control
- Same trusted PowerStep arch shell, more correction
- Built specifically for flat-foot biomechanics
- Excellent for posterior tibial tendon dysfunction (PTTD)
- Removable top cover for cleaning
✗ Cons
- Too aggressive for neutral-arch patients
- Needs longer break-in (10-14 days) due to stronger correction
- Adds 2-3 mm of stack height — won’t fit slim dress shoes
Dr. Tom’s Recommendation: When a patient comes in with significant flat feet AND symptoms (heel pain, arch pain, knee pain), the Original PowerStep isn’t aggressive enough. The Maxx is what gets prescribed. About 25% of my flat-footed patients end up here.
Low-Profile · Fits Dress Shoes & Narrow Casuals
3 mm slim profile with podiatrist-designed tri-planar arch technology. Engineered specifically to fit inside dress shoes, oxfords, loafers, and women’s flats without crowding the toe box. Vionic was founded by an Australian podiatrist.
✓ Pros
- 3 mm slim profile (vs 7-10 mm for standard orthotics)
- Tri-planar arch technology adds support without bulk
- Built-in deep heel cup despite slim design
- Fits dress shoes WITHOUT having to remove the factory insole
- Trim-to-fit · APMA-accepted
✗ Cons
- Less arch support than full-volume orthotics
- Top cover wears faster than thicker alternatives
- Not enough correction for severe foot deformities
Dr. Tom’s Recommendation: My default when a patient says ‘I need orthotics but I have to wear dress shoes for work.’ Slim enough to fit in oxfords and pumps without the heel sliding out. The single highest-impact change you can make for office workers with foot pain.
Built-In Metatarsal Pad · Morton’s Neuroma · Ball-of-Foot Pain
Standard Pinnacle orthotic with a built-in metatarsal pad positioned proximal to the metatarsal heads — the exact location that offloads neuromas and metatarsalgia. No need for separate met pads or pad placement guesswork.
✓ Pros
- Built-in met pad eliminates DIY pad placement errors
- Specifically designed for Morton’s neuroma + metatarsalgia
- Same trusted PowerStep arch + heel cup platform
- Top cover protects sensitive forefoot skin
- Faster relief than orthotics + add-on met pads
✗ Cons
- Met pad position is fixed (can’t fine-tune individual placement)
- Some patients with very small or very large feet need custom
- Slightly thicker than the standard Pinnacle
Dr. Tom’s Recommendation: If a patient has Morton’s neuroma, sesamoiditis, or generalized ball-of-foot pain (metatarsalgia), this saves a clinic visit and a prescription. The built-in pad placement is anatomically correct for 80% of feet. Way better than DIY met pads.
Adaptive Dynamic Arch · Athletic & Daily Wear
Currex’s flagship adaptive arch technology — the orthotic flexes with your gait instead of fighting it. Different stiffness zones along the length give you targeted support at the heel, midfoot, and forefoot. Available in three arch heights (low/medium/high).
✓ Pros
- Dynamic flex zones adapt to natural gait cycle
- Three arch heights ensure precise fit
- Lighter than rigid orthotics (no ‘heavy foot’ feel)
- Excellent for runners and athletic walkers
- European podiatric design (German engineering)
✗ Cons
- More expensive than PowerStep Original ($55-65 typically)
- Less aggressive correction than Pinnacle Maxx for severe cases
- Three arch heights means you must self-select correctly
Dr. Tom’s Recommendation: I started recommending Currex three years ago for runners who said PowerStep felt ‘too rigid.’ The dynamic flex zones respect natural gait. Best for active patients who walk 8K+ steps daily and don’t need maximum motion control.
Running-Specific · Heel Strike + Forefoot Strike Compatible
Currex’s purpose-built running orthotic. The midfoot flex zone is positioned for runner’s gait mechanics, with a flared heel cushion for heel strikers and a forefoot rocker for midfoot/forefoot strikers. Tested on 1000+ runners during product development.
✓ Pros
- Designed by German biomechanics lab specifically for runners
- Dynamic arch flexes with running gait (not static like PowerStep)
- Three arch heights (low/medium/high)
- Reduces overuse injury risk in mid-distance runners
- Lightweight (no impact on cadence)
✗ Cons
- Premium price ($60-75)
- Not aggressive enough for severe over-pronators (use Pinnacle Maxx)
- Runner-specific design = less ideal for daily walking shoes
Dr. Tom’s Recommendation: If a patient runs 20+ miles per week and has plantar fasciitis or shin splints, this is the orthotic I prescribe. The dynamic flex zones respect running biomechanics in a way that no rigid PowerStep can match. Pricier but worth it for serious runners.
Cavus Foot & High-Arch Patients
Polyurethane base with a deeper heel cup and higher arch profile than PowerStep — built for cavus (high-arched) feet that need maximum cushion and support. The 5-zone cushioning system addresses the unique pressure points of high-arch feet.
✓ Pros
- Deeper heel cup centers the heel for cavus foot stability
- Higher arch profile fills the void under high arches
- 5-zone cushioning addresses cavus foot pressure points
- Polyurethane base lasts 12+ months
- Available in Wide width
✗ Cons
- Too tall/aggressive for normal or low arches
- Won’t fit slim dress shoes
- Pricier than PowerStep Original
- Some patients find the arch height uncomfortable initially
Dr. Tom’s Recommendation: Cavus foot patients are often misdiagnosed and given low-arch orthotics — that makes everything worse. Spenco’s Total Support has the arch profile that high-arch feet actually need. About 15% of my patients have cavus feet; this is what they wear.
Cushion Layer · Standing All Day · Gel Pressure Relief
NOT a true biomechanical orthotic — this is a cushion insole. But for patients who want gel pressure relief instead of arch correction (or to add ON TOP of factory insoles in work boots), this is the best gel option on Amazon.
✓ Pros
- Genuine gel cushioning (not foam pretending to be gel)
- Targeted gel waves under heel and ball of foot
- Trim-to-fit · works in most shoe types
- Sub-$15 price (most affordable option in this list)
- Massaging texture is genuinely soothing
✗ Cons
- ZERO arch support — this is cushion only
- Won’t fix plantar fasciitis or flat-foot issues
- Compresses faster than PowerStep (4-6 months)
- Top cover wears through in high-mileage applications
Dr. Tom’s Recommendation: I recommend these to patients who tell me ‘I just want my feet to stop hurting at the end of my shift’ and who don’t have a biomechanical issue. Construction workers, factory workers, retail. Pure cushion does the job for them.
Tight-Fitting Shoes · Cycling Shoes · Hockey Skates
PowerStep Pinnacle’s slim version of their famous Green insole. The trademark stabilizer cap is preserved but the overall thickness is reduced — works in cycling shoes, hockey skates, ski boots, and other tight-fitting footwear that the standard PowerStep Pinnacle can’t fit into.
✓ Pros
- Stabilizer cap centers the heel (PowerStep Pinnacle’s signature feature)
- Slim profile fits tight athletic footwear
- Lasts 12+ months daily wear
- Excellent for cycling shoes specifically
- Built-in odor-control treatment
✗ Cons
- Premium price ($45-55)
- Less cushion than PowerStep equivalents
- Not as aggressive correction as Pinnacle Maxx for flat feet
- The signature ‘heel cup feel’ takes 1-2 weeks to adapt to
Dr. Tom’s Recommendation: If you’re a cyclist with foot numbness, hot spots, or knee pain — this is the orthotic. The stabilizer cap solves cycling-specific biomechanical issues that no other orthotic addresses. Worth the premium for athletes.
None of these solving your foot pain?
Some patients (about 30%) need custom-molded prescription orthotics. We make 3D-scanned custom orthotics in our Howell and Bloomfield Hills offices — specifically built for your foot mechanics.
Schedule a Custom Orthotic Fitting →FSA/HSA eligible · Most insurance accepted · (810) 206-1402
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
Frequently Asked Questions
Can I see a podiatrist for heel pain without a referral?
How long does plantar fasciitis take to heal?
Should I walk on my heel if it hurts?
What does a podiatrist do for heel pain?
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
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