"Sever's disease" isn't a disease. It's a label — and a fixable one.
I've worked with around ten kids in the last while with heel pain like this, some diagnosed, some not. Almost every one of them was doing the same thing with their feet — and almost none of it had anything to do with their footy boots.
I want to say something a bit blunt up front: I think "Sever's disease" is a stupid label. It's not a disease in any real sense — it's irritated tissue at a growth plate, and it's a request from the body for something to change. Calling it a disease makes it sound like a life sentence. It isn't one. In my experience it's one of the more fixable things I see.
What's Actually Happening At The Heel
Every single step a kid takes running puts roughly two and a half times their bodyweight through the foot that lands. That's not a typo — it's just how running works, in every kid, every stride.
Where that force lands matters enormously. In pretty much every kid I've assessed with heel pain — whether they came in for the pain itself or just for a running technique analysis — the pattern looks the same: a heavy heel strike, landing well in front of their centre of gravity. That's a dead stop. All that load slams into one small spot, the heel, again and again, stride after stride, session after session.
Compare that to a tripod landing — foot striking flatter, closer to underneath the body — and that same load gets spread across the whole foot instead of concentrated on one bone that's still growing. Same force. Completely different outcome for the tissue underneath.
A Real Case: The Ten-Year-Old Who Couldn't Get His Boots On
Ten years old, footy, heel pain stopped him playing
A dad brought his son in — about ten years old — because his heel kept flaring up and he'd had to stop playing footy. He couldn't run for long. He couldn't even get his footy boots on without pain.
They came to me expecting a running technique conversation, and yes, that mattered — his foot strike was the classic heavy heel-first pattern described above. But the bigger conversation wasn't actually about his footy boots at all. Footy boots only go on for two to four hours a week. The shoes doing the real damage were the ones he wore every day: his school shoes, his casual sneakers. Those are the shoes his feet were adapting to, hour after hour, day after day.
Those everyday shoes had a heel raise and heavy cushioning — which sounds protective, but does the opposite. A cushioned, raised-heel shoe does the work the foot is supposed to do itself, so the foot gets stiff, immobile and weak. And because the cushioning absorbs the impact, the kid can't actually feel the heavy heel strike happening. The shoe hides the exact feedback that would otherwise tell his body to change how it lands — so the poor technique gets reinforced, not corrected, every single day he wears them.
Once we addressed both pieces — the running technique and the everyday shoes, not just the boots — that pressure on the calf and Achilles pulling on the heel started coming off, and real strength started building from within instead of being propped up from outside.
How Long Does It Actually Take?
I'm not going to give you a neat "6 weeks and you're fixed" answer, because it isn't true and case-by-case it varies. It depends how consistently the kid does the strengthening and balance work, and — critically — how quickly the parents are willing to get them out of the cushioned, stability shoes.
Here's the honest version: if a kid and their parents genuinely listen and act on all of it, I think heel pain like this can start disappearing within a week. Pain is the body asking for a change. Take away the load — the heel strike, the stiff cushioned shoes — and you take away the reason the area is annoyed. It settles.
But not every kid does it perfectly, and I want to be honest about that too. The reason it can take longer usually isn't biology — kids this age are young and adaptable, and their tissue responds well. The reason is compliance. Specifically: shoes.
Why The Shoes Are The Hard Part
Footwear today is fashion over function. It's genuinely difficult to get a kid out of their Nikes or Adidas and into something more minimalist — I understand why. There's real social pressure in that, especially once they hit high school.
I remember being at school myself when the first laceless school shoes came out. I could have been the first kid in my class wearing them. I didn't. There was no way I was committing social suicide by being different. So I genuinely understand the resistance — it's not stubbornness, it's just what it's like being a kid.
What's worked for me is reframing the conversation entirely, away from how the shoes look and onto what they do. I'll ask a kid directly: what's more important to you — looking good, or actually getting better at your sport? Do you want fewer injuries? Do you want to run faster? I put it on performance and how their body feels, not on the shoe as a status object. Most kids, when it's framed as "this is holding your actual game back," start to listen differently than when it's framed as a parental rule.
If a kid or a parent isn't willing to change the shoes, I'll say it plainly: they may be living with this pain for a lot longer than they need to. Orthotics and big cushioned shoes can take the symptoms away for a week or two. But they set up a much longer journey of pain, because the foot underneath stays stiff, immobile and weak the entire time it's propped up externally.
The Shoe Test — Do This Tonight
Look down at your own shoes first
Ask yourself honestly: do these shoes actually look like my feet? For roughly 99% of modern shoes, the answer is no — and the toes are the giveaway.
Try this: take the insole out of the shoe. Put it on the ground. Stand on it barefoot. Look at where your toes land.
I'd put money on your toes splaying out over the edge of that insole. That's how much the toe box has been squeezing your foot into a shape it was never designed to be in — and it's happening to your kids in exactly the same way, every single day, in the shoes they wear far more than any sport boot.
Growth Spurts Make It Worse
I've noticed lately more kids coming through with general aches through the lower limbs — knees, ankles, heels — right around a growth spurt. Their body is growing, but modern life (shoes included) doesn't really let the body grow and move the way it's designed to. That growth ends up a bit stifled, and I think that's a real part of where these growth-plate pains come from.
Feet have around half a million nerve endings on the sole. They're built to feel the ground, respond to it, and tell the rest of the body what to do — balance, posture, everything upstream. A kid who's spent years in stiff, cushioned shoes has effectively had that feedback loop switched off. Let feet grow the way nature intended — barefoot, moving, out of chairs, standing more — and a lot of this resolves itself as a natural consequence.
What Actually Helps — Beyond Just The Shoes
Alongside the shoe conversation, there are two things I give to pretty much every kid I see with this:
Barefoot Balance Work
Standing and balancing barefoot on a flat surface. Most kids — most adults — have lost real balance from years in shoes. Balance work reconnects the feet to the hips and glutes, so the body starts working as one unit again instead of the foot being switched off from everything above it.
Mobility Ball Rolling
Rolling out the bottom of the foot on a mobility ball. It gets tissue that's been stuck and compressed inside cushioned shoes moving again — better blood flow, better tissue quality, less stiffness through the plantar fascia and up into the heel.
But I'll say this clearly: if the shoes don't change, these two things will only ever manage the symptom. You'll never actually address the foot pain long-term without addressing what the foot lives in for 40-plus hours a week.
Why I Have A Problem With The Usual Advice
Here's something that genuinely frustrates me about the health industry. The vast majority of podiatrists, when a kid comes in with heel pain, will put them into an external aid — orthotics, more supportive shoes — and tell the family that's the fix. What they usually don't do is strengthen the feet, mobilise them, or teach the kid to use their body the way it was actually designed.
I see adults who've worn orthotics for ten, fifteen years and are still getting the same niggles. Of course they are — those are external braces they never needed to be dependent on forever. Yes, that support can get someone out of pain faster in the short term, and sometimes that trade-off is worth it to start with. But without ever being given the education or the pathway out of the orthotic, out of the cushioned shoe, that short-term fix becomes a long-term dependency.
Why I Look At Feet First — My Own Story
Mick Breen — Myotherapist & Youth Running Coach
Almost 20 years coaching, 8 years as a myotherapist. This whole journey started with my own body — three ACL reconstructions. Two of the three happened with zero contact. Pure sidestepping at full pace, and my body simply didn't have the stability to hold it. Looking back at every shoe I wore through that period — big cushioned trainers, unstable, overbuilt footy boots — I can see exactly why. Nine times out of ten, a non-contact knee injury isn't actually the knee's fault. It's something upstream in the hip, or downstream in the foot and ankle. The feet are where we connect to the ground, and that's the foundation everything else is built on.
Since getting out of big cushioned shoes myself, I've gotten stronger, run better, felt better, and had far fewer injuries — and my feet have genuinely never felt better. Every client I see now, kid or adult, I look at their shoes first. It's become the single biggest conversation I have with parents when we're teaching a kid to run — 99% of them turn up in big cushioned Asics, Hokas or Nikes, and that's always where we start.
This Isn't On You
I want to be clear about something before you feel bad about the shoes already in your cupboard: none of this is the parents' fault, and it isn't the kid's fault either. It's the result of genuinely massive marketing budgets from companies like Nike and Adidas, selling cushioning and support as protection for decades. Of course we believed it — it's sold as safety, and it's tied up in status and image, especially for teenagers.
You're not undoing bad parenting. You're just working with information that most people were never given.
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This article reflects the clinical experience and personal opinion of Mick Breen, a myotherapist and youth running coach. It is general movement-coaching information, not medical advice, and nothing in it is a diagnosis. Heel and lower leg pain in growing children has several possible causes. If your child is in pain, please have them assessed by your GP, physiotherapist or podiatrist before starting any new exercise program or changing footwear used for medical reasons.