Sever's Disease: Why it's NOT "Growing Pains" & How to Fix it
Key insights: 60-second read
- "Growing pains" isn't good enough – growing is normal; pain is not. You don't need to wait until your child stops growing for heel pain to resolve.
- Hidden cause #1: feet pointing outward – turned out feet can ask the legs to collapse inward during movement, changing how the Achilles loads the heel.
- Hidden cause #2: restricted ankles & hips – restrictions in these areas can change the way we load the heel.
- The squat test – can your child squat with their feet straight, knees out, and heels down? If not, this may indicate some hidden mechanical handbrakes we need to address.
- Three key exercises – banded ankle stretch, soleus calf stretch (with contract‑relax), and couch stretch for hips.
If you or your child are dealing with heel pain - also known as Sever's disease - I'd like to show you how to make it feel better. Not just manage it and hope that it eventually goes away - but fix the underlying mechanical cause.
In this post, we're going to talk about what I find to be the root underlying cause of Sever's disease, why the label of "growing pains" isn't good enough, and ultimately go through a number of exercises that will hopefully get to the root mechanical cause of why that exact part of the heel has become sore in the first place.
On this page
Why "Growing Pains" Isn't Good Enough
As a physio who works with local sporting teams and young athletes, I see a lot of heel pain. Importantly, there's a common misconception that Sever's disease is just "growing pains". That because a young athlete is growing it's not abnormal for certain parts of the body to become sore along the way.
But the biggest issue I have with this label is that growing is normal - and pain is NOT.
Personal note: I had Osgood Schlatter disease (growing pains of the knee) as a kid. The advice back then was to struggle through and manage it until I stopped growing and it'd go away. Now as a physio, I know it should have taken days or weeks, not years, to settle. Ultimately, growing isn't the problem. Running, being an athlete - these are normal things that expose hidden mechanical issues. We just have to find what they are.
If we're ever going to completely solve a person's Sever's disease, we don't have to wait until they stop growing. Instead, we need to figure out how they load up that exact part of their body and why. Improve this (and settle the symptoms), and we can have the opportunity to fix it.
Hidden Causes of Sever's Disease
There are two simple things I find clinically that may set a young athlete up for Sever's disease.
1. The direction their feet point
Standing, walking, or running with feet that point outwards (not straight), can be a big reason why Sever's disease exists. Biomechanically, when moving forwards, our body should move in a linear plane - ideally over straight feet. If our feet turn out, our legs are more likely to collapse inward relative to where the feet are pointing. This changes how the Achilles tendon loads the back of the heel.
Many people associate flat feet with Sever's, but arch collapse can be another consequence of this outward-foot pattern as well. So the first and simplest place to start when trying to solve Sever's disease is to start rewiring this habit. Aim for straight feet when standing, walking, and running.
2. The squat test
The simple squat is a fantastic way to understand how a person moves, what they might be missing, and where - all inherently useful things for solving Sever's disease.
Start with you feet straight, and rotate your knees out (without letting your big toe lift up off the ground). Then, squat down as deep as you can without your:
- Feet turning out
- Knees collapsing inward
- Heels lifting off the ground
- Back rounding at the bottom
- Falling backwards
Each of these compensations can be our body's way of working around restrictions - most commonly at the ankles and/or hips. In an ideal world, we should all be able to squat to full depth with our feet remaining straight, knees staying out, and heels staying down - without falling backwards or wanting to round our back at the bottom. If you can't, it indicates that you might be missing something you deserve to have.
Exercise 1: Banded Ankle Stretch
Why: Ankle joint restrictions are one of the most significant contributors to Sever's disease I see clinically. Freeing up the ankle changes how the heel is loaded.
Setup: Secure a power band (or stretch band) to something sturdy. Place the band just below the bones at the bottom of the ankle. Take a decent step away from the band so there's tension. Keep the foot straight, knees out (same squat position).
The stretch: Gently close down that back ankle - lean forward while keeping the heel down. Find a position where you feel a good stretch at the back of the ankle without irritating the heel symptoms. Hold for 30–60 seconds. You can gently oscillate in and out of the stretch.
Key detail: If you have an ankle restriction, your leg may try to dump inward to compensate. Resist that - keep the foot straight and knee out.
Retest: After doing this, walk around. You should feel lighter, less tight, and hopefully less tender straight away.
Exercise 2: Soleus Calf Stretch (with Contract‑Relax)
Why: The soleus (deep calf muscle) sits lower down and influences ankle range and Achilles load. Traditional calf stretches often miss it.
Setup: Stand on the edge of a step with your heel over the edge. Shoes on or off - whatever is comfortable.
The stretch: Gently bend your knee to target the soleus (straight leg targets the gastrocnemius). Let your heel drop down to a comfortable stretch.
Contract‑relax technique (makes it more effective):
- Find a point of mild tightness.
- Tense the muscle (try to push into the stretch without moving) for 5–10 seconds.
- Relax completely. You should feel able to sink a little deeper.
- Repeat this process for 1–2 minutes or until you stop making change.
This uses a neurological reflex to encourage the tissue to release more effectively than passive stretching alone.
Exercise 3: Couch Stretch (for Tight Hips)
Why: Tight hips affect how the entire leg functions. If the front of the hip is restricted, it can change the way everything below it is loaded - including the heel.
Setup: Kneel with one knee against a wall or couch. The other leg is in front in a kind of lunge shape. Keep your back straight.
For younger athletes: If the floor position is too intense, start with a chair - rest the back knee on the chair instead.
The stretch: Find your comfortable limit. Then use the same contract‑relax technique: squeeze your glute and tense the front of the hip for 5–10 seconds, relax, then try to sink a little deeper. Repeat until you feel release.
Goal: Everyone - especially young athletes - should be able to be in this position (or a modified version) without their tissues screaming.
Final Thoughts: Moving Beyond "Growing Pains"
Sever's disease doesn't exist because we're growing. Yes, growth can be part of the process, but because growing, running, jumping, and playing is normal - it's what the body is designed to do - we need to look beyond those concepts for clues.
If you or your child can't squat with their feet straight, knees out, to full depth without the heels lifting or wanting to fall backwards, then something is missing. Tight ankles and tight hips may not only set us up for Sever's, but they're an unnecessary handbrake to speed, power, and endurance.
If we can find and resolve these hidden mechanical issues, and encourage our young athletes to keep their feet straight and develop ideal squat mechanics, we can give them a genuine chance to resolve their Sever's disease in weeks and not months or years - regardless of how much they grow.
Don't be like me. Fix the hidden, underlying cause of Sever's disease rather than just manage the symptoms and hope for the best.
⏱️ Video timestamps for quick navigation:
0:00 – Introduction to Sever's disease
0:33 – Why "growing pains" isn't good enough
2:08 – Hidden causes: feet pointing outward
4:13 – The squat test
5:33 – Banded ankle stretch
7:36 – Soleus calf stretch (contract‑relax)
9:18 – Couch stretch for tight hips
10:41 – Final thoughts & what to aim for
If you found this video helpful, please consider leaving a like and subscribing to the Your Wellness Nerd YouTube channel - we've just passed 100,000 subscribers! I genuinely hope this helps you or your young athlete get through Sever's as quickly as possible.
– Grant
Frequently Asked Questions
Can Sever's disease occur in only one heel?
Yes. Often one side is more affected because mechanical issues (like foot alignment or hip stiffness) are asymmetrical. This is actually a clue - if one side is painful, compare movement patterns side‑to‑side to find the likely mechanical cause.
Should my child stop sport until the pain goes away?
Not necessarily. By all means manage their training and playing load if necessary, but stopping sport completely isn't the long-term solution. Exercises like the ones above aim to normalise the way they load their heels, so they can return to activity with better mechanics and no pain.
How long does it take to resolve Sever's with these exercises?
With consistent work (daily exercises focusing on ankle mobility, calf flexibility, and hip mobility), many young athletes see significant improvement in day and weeks - not months or years. The key is addressing the underlying mechanics, not just treating the symptom.
One profound insight from this post
"Growing is normal, pain is not. You shouldn't have to wait until your child stops growing for their heel pain to go away."
Living With Persistent Pain?
If your pain has lasted longer than expected, feels disproportionate to activity, or hasn't responded to standard treatment, you may benefit from a broader approach. Learn more about our ankle pain physiotherapy services in Port Macquarie.
Need Personalised Guidance for Your Young Athlete?
If you'd like help uncovering the underlying mechanical issues causing heel pain, consider booking an online Telehealth consultation with Grant - available for young athletes and their families.
