Sever's Disease Michigan: Heel Pain in Children | DPM

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Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

What Is Sever’s Disease?

Sever’s disease (calcaneal apophysitis) is the most common cause of heel pain in children and adolescents, typically affecting active kids ages 8–14 during their growth spurts. Despite its alarming name, Sever’s disease is not a “disease” in the traditional sense — it is a painful irritation of the growth plate (apophysis) at the back of the heel bone (calcaneus) where the Achilles tendon attaches. As children grow, the heel bone’s growth plate is the last part to harden (ossify), making it temporarily vulnerable to stress from physical activity. Sever’s disease is benign and self-limiting — it resolves once the growth plate fuses in the mid-teens — but it can cause significant heel pain during the active years if not properly managed.

Who Gets Sever’s Disease?

Sever’s disease most commonly affects: boys ages 10–14 and girls ages 8–13 (corresponding to peak growth velocity); active children who play high-impact sports — soccer, basketball, gymnastics, running, baseball; children experiencing a rapid growth spurt; children with flat feet (overpronation), high arches, or tight Achilles tendons; and overweight children who place increased load on the heel. In Michigan, Sever’s disease commonly presents in children during fall sports season (soccer, cross-country) and spring sports (baseball, track). Parents often bring their child to Balance Foot & Ankle when persistent heel pain has not responded to rest.

Symptoms of Sever’s Disease

Heel pain at the back (posterior) of one or both heels — worse with activity and better with rest; pain on direct squeezing of the heel bone from the sides (the “squeeze test” is highly sensitive and specific for Sever’s disease); limping or tip-toe gait to avoid loading the painful heel; pain worse at the start of activity, improving somewhat with warm-up, then worsening again after activity stops; morning heel pain (similar to plantar fasciitis in adults but at the posterior heel, not the bottom). Both heels are affected in approximately 60% of cases, though one side is usually worse than the other.

Diagnosis and X-Ray Findings

Sever’s disease is a clinical diagnosis based on age, activity level, and the characteristic heel pain pattern. X-rays of the heel are typically obtained to rule out fracture, bone tumor, or infection — the radiographic appearance of Sever’s disease (sclerosis and fragmentation of the calcaneal apophysis) is a normal variant in growing children and should not be over-interpreted as confirming pathology. MRI is rarely needed but shows apophyseal stress reaction in uncertain cases. The positive squeeze test, age, and sport history are the primary diagnostic criteria.

Treatment of Sever’s Disease

Activity modification: reducing or temporarily stopping the high-impact activity that provokes pain — not complete rest, but modified activity that keeps pain below 3–4/10. Complete rest is rarely necessary and may be counterproductive to the child’s development. Heel lifts: bilateral heel lifts (3/8–1/2 inch) in both shoes reduce Achilles tendon tension on the growth plate — often dramatically reduce pain within 1–2 weeks. Available inexpensively at pharmacies or can be custom-fitted at our office. Stretching: Achilles tendon stretching and calf flexibility exercises performed 3–4 times daily are the most important treatment for most children. Night splints: for children with very tight Achilles tendons, a dorsiflexion night splint maintains the stretch overnight. Custom orthotics: for children with significant flat foot or high arch contributing to Sever’s disease, custom orthotics address the biomechanical cause and prevent recurrence during the remainder of the growth years. Icing: 15 minutes after activity reduces inflammation. Most children improve significantly within 2–4 weeks of consistent treatment and return to full sport within 4–8 weeks.

Schedule Your Child’s Heel Pain Evaluation

Dr. Tom Biernacki evaluates pediatric foot and ankle conditions including Sever’s disease at Balance Foot & Ankle in Howell and Bloomfield Hills. If your child is limping or complaining of heel pain during sports, call (810) 206-1402. We see pediatric patients and provide child-friendly explanations and treatment plans that keep kids in their sport whenever possible.

Frequently Asked Questions

Dr. Tom Biernacki, DPM is a board-certified podiatric surgeon at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan. He evaluates and treats pediatric foot and ankle conditions including Sever’s disease, flat feet in children, and growth-related foot pain.

In-Office Treatment at Balance Foot & Ankle

If home care isn’t resolving your child’s heel pain, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.

Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.

Differential Diagnosis: What Else Could It Be?

Several conditions share symptoms with Plantar Fasciitis and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:

• Baxter’s neuropathy. Compressed first branch of lateral plantar nerve — burning medial heel pain rather than first-step sharpness.
• Calcaneal stress fracture. Squeeze test of the heel reproduces pain anywhere; PF is reproduced only at the medial-plantar attachment.
• Heel spur (incidental). Spurs show on X-ray but rarely cause pain on their own — treat the fascia, not the spur.

If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.

Most Common Mistake We See

The most common mistake we see is: Stretching aggressively before the fascia warms up. Fix: apply heat or move the foot through gentle circles for 3-5 minutes before your first morning steps, then stretch.

Warning Signs That Need Same-Day Care

Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)

If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.

What is Heel pain?

Heel pain is a common foot/ankle condition that affects mobility and quality of life. Understanding the underlying cause is the first step in successful treatment. Our podiatrists at Balance Foot & Ankle perform a hands-on biomechanical exam, review your activity history, and use diagnostic imaging when appropriate to identify the root cause—not just treat the symptom. Many patients have been told to “rest and ice” without a deeper diagnostic workup; our approach is different.

Symptoms and warning signs

Common signs of heel pain include pain that worsens with activity, morning stiffness, swelling, tenderness when palpated, and difficulty bearing weight. If you experience sudden severe pain, inability to walk, visible deformity, numbness or color change, contact our office the same day or visit urgent care—these can signal a more serious injury such as a fracture, tendon rupture, or vascular compromise. Diabetics with any foot wound should seek same-day care.

Conservative treatment options

Most cases of heel pain respond to non-surgical care: structured rest, supportive footwear changes, custom orthotics, targeted stretching and strengthening protocols, anti-inflammatory medications when medically appropriate, and in-office procedures such as ultrasound-guided injections. We also offer advanced therapies including MLS laser therapy, EPAT/shockwave, regenerative injections, and image-guided procedures. Treatment is sequenced from least invasive to most invasive, and we explain the rationale at every step.

When is surgery considered?

Surgery is reserved for cases that fail 3-6 months of well-structured conservative care, when there is structural pathology (severe deformity, complete tear, advanced arthritis), or when imaging shows damage that will not heal without intervention. Our surgeons have performed 3,000+ foot and ankle procedures and prioritize minimally-invasive techniques whenever appropriate. We discuss recovery timelines, return-to-activity milestones, and realistic outcome expectations before any procedure is scheduled.

Recovery timeline and prevention

Recovery from heel pain varies based on severity and chosen treatment path. Conservative cases often improve within 4-8 weeks with consistent adherence to the protocol. Post-procedural recovery may range from a few days (in-office procedures) to several months (reconstructive surgery). Long-term prevention involves footwear assessment, activity modification, structured strengthening, and regular check-ins with your podiatrist if you have a history of recurrence. We provide written home-exercise plans and digital follow-up support.

Frequently Asked Questions

How long does plantar fasciitis take to heal?

Most plantar fasciitis cases resolve within 6–12 months with consistent treatment. In our clinic, patients who begin care within the first 8 weeks see 80% improvement by month 3. Chronic cases — pain lasting over a year — typically require PRP injections or surgical intervention, but fewer than 5% of our patients reach that point. Starting treatment early is the single biggest factor in shortening recovery.

Why is plantar fasciitis pain worst in the morning?

Overnight, the plantar fascia contracts in a shortened position. Your first steps stretch it abruptly, causing micro-tears at the heel attachment and sharp pain. This ‘first-step pain’ that eases after 10–15 minutes is the hallmark diagnostic sign. If your pain worsens throughout the day rather than improving, a different diagnosis — stress fracture, fat pad atrophy, or nerve entrapment — should be explored.

Can I walk or run with plantar fasciitis?

You can often continue with modifications, especially in early-stage cases. Reduce mileage by 30–50%, avoid hills and speed work, and run on softer surfaces. Add aggressive calf stretching before and after. If pain exceeds 4/10 during activity, stop — pushing through moderate-to-severe pain causes scar tissue formation that can double your recovery time. We reassess runners every 3 weeks to adjust the plan.

Does plantar fasciitis require surgery?

Surgery is required in fewer than 5% of cases. We exhaust conservative options first: custom orthotics, physical therapy, night splints, corticosteroid injections, and shockwave therapy. If those fail after 6–12 months of consistent treatment, plantar fascia release or PRP is considered. In our practice, patients who follow a structured protocol almost never reach surgery.

What shoes help plantar fasciitis the most?

The three features that matter most: firm arch support (not soft cushioning — soft foam collapses under load), a slight heel elevation of 8–12mm to reduce fascia tension, and a wide, deep toe box. Motion-control and stability shoes outperform neutral cushioned shoes for most plantar fasciitis patients. Avoid flat shoes, flip-flops, and going barefoot on hard floors entirely.

Do I need custom orthotics, or will store-bought insoles work?

For mild-to-moderate plantar fasciitis, high-quality OTC insoles (Superfeet, Powerstep) work well for about 60% of patients. Custom orthotics are worth it when: your arch collapse is severe, OTC insoles haven’t helped after 8 weeks, or you have a secondary issue like leg-length discrepancy or overpronation driving the problem. We cast custom orthotics in-office when clinically indicated — typically covered by most PPO plans.

Is plantar fasciitis the same as a heel spur?

No — they’re related but different. A heel spur is a bony calcium deposit that forms on the bottom of the heel bone; plantar fasciitis is inflammation of the fascia ligament. About 70% of patients with plantar fasciitis have a heel spur on X-ray, but the spur is rarely the source of pain. Treating the fascia inflammation resolves symptoms in most cases without removing the spur.

What stretches actually work for plantar fasciitis?

The two most evidence-supported stretches: (1) Seated towel stretch — loop a towel around your foot, pull toes toward you, hold 30 seconds, repeat 3x before getting out of bed. (2) Calf-wall stretch with a straight knee and a bent knee — targets both the gastrocnemius and soleus. Research shows stretching 3x daily reduces symptoms significantly within 8 weeks. The Strassburg sock worn overnight is the highest-impact passive stretch available.

Can plantar fasciitis come back after it heals?

Yes — recurrence rate is 15–25% in the first year without maintenance. The three biggest recurrence triggers: returning to the shoes that caused the problem, stopping stretching when pain disappears, and sudden increases in activity. Patients who continue daily stretching, wear supportive footwear consistently, and use orthotics long-term have recurrence rates under 5% in our practice.

When should I see a podiatrist for heel pain?

See a podiatrist if: pain is severe and limits daily walking, pain hasn’t improved after 4 weeks of rest and stretching, pain is getting progressively worse, you’re having pain at night or at rest, or the pain is on the back or side of your heel rather than the bottom. Night and resting pain can indicate stress fractures, nerve compression, or Achilles pathology — conditions that need imaging to rule out.

What’s the difference between plantar fasciitis and tarsal tunnel syndrome?

Both cause heel pain but feel different. Plantar fasciitis pain is sharp, focal, and worst with first steps. Tarsal tunnel pain is burning, tingling, or electric — often radiating into the arch and toes — and worsens with prolonged standing. Tarsal tunnel is nerve compression (like carpal tunnel in the wrist); plantar fasciitis is ligament degeneration. A nerve conduction study and Tinel’s sign test differentiate them. Misdiagnosis is common — about 20% of chronic plantar fasciitis cases are actually tarsal tunnel.