Specialista in Ortopedia Pediatrica
Heel pain / Sever's disease
Home Exercise Program
Not every exercise listed here is suitable for every child: the selection is individual and is defined during the consultation.
1.Calf stretch (essential)
Calf tension is the main factor pulling on the heel
GASTROCNEMIUS: Facing wall, back leg with straight knee, heel pressed down. Push hips forward. SOLEUS: Same position but slightly bending back knee. Both positions are important! Stretching should be gentle and never painful - a tight calf "pulls" the Achilles tendon which in turn pulls the heel.
3 × 20-30 seconds, twice daily. Gentle if pain present
2.Step stretch (eccentric)
More intense stretch to lengthen Achilles tendon in a controlled way
Stand on step edge, heels hanging off. ALWAYS hold railing. Slowly let heels drop below step level. Hold 20-30 seconds feeling calf stretch. Rise slowly. If too intense, start with both feet together.
3 × 20-30 seconds, 1-2 times daily (not in acute phase)
3.Ankle mobility (alphabet, circles)
Maintains joint mobility and improves circulation
Seated, with foot raised off floor. ALPHABET: "Write" alphabet letters in the air using toe tip. CIRCLES: Make complete circles with ankle in both directions. These exercises gently move the ankle without loading the heel.
2-3 minutes of mobility, 2-3 times daily
4.Ball massage (foot sole)
Reduces plantar fascia tension that may contribute to pain
Seated, roll tennis ball under entire sole, from arch to heel. Apply moderate pressure. AVOID pressing directly on painful heel spot. For anti-inflammatory effect, use frozen water bottle (cryotherapy + massage).
3-5 minutes per foot, 1-2 times daily
5.Eccentric calf strengthening (pain-free)
Gradual strengthening, only when acute pain subsides
ONLY when acute pain has subsided. CALF RAISES: Standing, slowly rise onto toes, then lower. Start with both feet, then progress to single leg. If it causes pain, stop and retry after a few days. Strengthening prevents recurrence but shouldn't be done in acute phase.
Start with 3 × 10 bilateral, progress to 3 × 15 single leg
6.Toe yoga and foot control
Improves neuromuscular control of the foot
Seated or standing. Alternate: lift big toe keeping other toes down → lower big toe and lift other 4 toes. Then: practice foot "dome" (short-foot), trying to raise arch without curling toes. This exercise doesn't load heel and improves foot control.
10-15 reps per movement
7.Single-leg balance
Improves proprioception and foot stability
Stand on one leg, initially near support. Weight should be distributed over entire foot, not concentrated on heel. Progression: eyes open → eyes closed → soft surface. This exercise improves control without excessive stress on heel.
3 × 30 seconds per leg, progressing when stable
8.Tibialis anterior strengthening (seated with band)
Strengthens anterior leg muscles WITHOUT loading the heel
Seated with leg extended, wrap band around top of foot and fix other end to point in front (table leg, or hold with other hand). Pull foot toward yourself (dorsiflexion) against band resistance, then return slowly. This strengthens tibialis anterior without stressing the painful heel.
3 × 15 reps per foot, 1-2 times daily
RED FLAGS - When to stop and contact the doctor immediately
Stop the exercises immediately and contact the specialist (or go to the emergency department if severe) if any of the following occur:
- Pain at rest (not only during/after activity)
- Persistent limping
- Visible heel swelling
- Pain not improving after 2 weeks of reduced activity
- Fever, redness or warmth of the joint, or inability to bear weight
In case of doubt, always prefer a check-up over continuing the exercises.
Dott. Daniele Priano
Ortopedia Pediatrica - ASST Gaetano Pini-CTO
ortopediaevolutiva.com • 26/08/2026
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MioDottoreBefore You Start
Who is this guide for?
Athletic children (8-14 years) with heel pain from apophysitis (Sever's disease). Essential to reduce activity during acute pain.
What you need
Clear floor space, mat or soft surface, comfortable clothing. Some exercises may require resistance bands or supports.
Suggested frequency
Usually 1-2 times daily, as directed during the visit. Consistency is more important than intensity.
Common mistakes to avoid
- •Continuing intense sports activity during pain
- •Overly aggressive stretching
- •Not using recommended heel cushions
- •Returning to sports too soon
⚠️ Red flags — when to stop and contact the doctor immediately
Stop exercises immediately and contact the specialist if any of the following occur:
- Pain at rest (not only during/after activity)
- Persistent limping
- Visible heel swelling
- Pain not improving after 2 weeks of reduced activity
Detailed Exercises
- 1
Calf stretch (essential)
Calf tension is the main factor pulling on the heel
GASTROCNEMIUS: Facing wall, back leg with straight knee, heel pressed down. Push hips forward. SOLEUS: Same position but slightly bending back knee. Both positions are important! Stretching should be gentle and never painful - a tight calf "pulls" the Achilles tendon which in turn pulls the heel.
3 × 20-30 seconds, twice daily. Gentle if pain present - 2
Step stretch (eccentric)
More intense stretch to lengthen Achilles tendon in a controlled way
Stand on step edge, heels hanging off. ALWAYS hold railing. Slowly let heels drop below step level. Hold 20-30 seconds feeling calf stretch. Rise slowly. If too intense, start with both feet together.
3 × 20-30 seconds, 1-2 times daily (not in acute phase) - 3
Ankle mobility (alphabet, circles)
Maintains joint mobility and improves circulation
Seated, with foot raised off floor. ALPHABET: "Write" alphabet letters in the air using toe tip. CIRCLES: Make complete circles with ankle in both directions. These exercises gently move the ankle without loading the heel.
2-3 minutes of mobility, 2-3 times daily - 4
Ball massage (foot sole)
Reduces plantar fascia tension that may contribute to pain
Seated, roll tennis ball under entire sole, from arch to heel. Apply moderate pressure. AVOID pressing directly on painful heel spot. For anti-inflammatory effect, use frozen water bottle (cryotherapy + massage).
3-5 minutes per foot, 1-2 times daily - 5
Eccentric calf strengthening (pain-free)
Gradual strengthening, only when acute pain subsides
ONLY when acute pain has subsided. CALF RAISES: Standing, slowly rise onto toes, then lower. Start with both feet, then progress to single leg. If it causes pain, stop and retry after a few days. Strengthening prevents recurrence but shouldn't be done in acute phase.
Start with 3 × 10 bilateral, progress to 3 × 15 single leg - 6
Toe yoga and foot control
Improves neuromuscular control of the foot
Seated or standing. Alternate: lift big toe keeping other toes down → lower big toe and lift other 4 toes. Then: practice foot "dome" (short-foot), trying to raise arch without curling toes. This exercise doesn't load heel and improves foot control.
10-15 reps per movement - 7
Single-leg balance
Improves proprioception and foot stability
Stand on one leg, initially near support. Weight should be distributed over entire foot, not concentrated on heel. Progression: eyes open → eyes closed → soft surface. This exercise improves control without excessive stress on heel.
3 × 30 seconds per leg, progressing when stable - 8
Tibialis anterior strengthening (seated with band)
Strengthens anterior leg muscles WITHOUT loading the heel
Seated with leg extended, wrap band around top of foot and fix other end to point in front (table leg, or hold with other hand). Pull foot toward yourself (dorsiflexion) against band resistance, then return slowly. This strengthens tibialis anterior without stressing the painful heel.
3 × 15 reps per foot, 1-2 times daily
Frequently Asked Questions
How long does Sever's disease last?
Sever's disease resolves spontaneously when the calcaneal apophysis closes, generally between ages 12 and 15. Acute symptoms may last weeks or months, but with consistent stretching and sports load management, pain is effectively controlled.
Can my child continue playing soccer with Sever's disease?
It depends on pain intensity. In the acute phase, activity must be reduced. When pain is controlled, gradual resumption is possible. Heel cushions in sport shoes help reduce impact on the heel. Stretching before and after activity is essential.
Are heel cushions needed for Sever's disease?
Silicone or gel heel cushions are very helpful: they slightly elevate the heel reducing Achilles tendon tension and cushion the impact. They should be used in all shoes, both sport and daily, as long as pain persists.