Introduction

“My heel hurts and I can’t exercise,” “My foot hurts when I wake up in the morning.” These complaints, commonly seen in children from upper elementary to middle school age, may be caused by Sever’s disease (calcaneal apophysitis).

As a physical therapist working with many growing children, I have realized that Sever’s disease is not simply “growing pains” or “overuse,” but is deeply related to whole-body growth patterns and kinetic chain problems.

From an osteopathic perspective, based on the fundamental principle that “the body is a unit,” heel pain can also be understood as an integrative problem of whole-body structure and function.

Today, I will organize the causes and prognosis of Sever’s disease based on scientific evidence and discuss the approaches to enhance natural healing capacity that osteopathy can provide.

1. Pathophysiological Understanding of Sever’s Disease

Characteristics of Growth Plate Cartilage in Growing Children

Sever’s disease is an inflammatory condition caused by repetitive stress applied to the growth plate cartilage of the calcaneus (heel bone) during the growth period.

Vulnerability of Growth Plate Cartilage

• Rich in Type II collagen with low mechanical strength
• Limited vascular supply with restricted repair capacity
• Strongly influenced by growth hormones and IGF-1

Mechanical Stress at Achilles Tendon Attachment Site The calcaneal apophysis is where traction forces from the Achilles tendon and plantar fascia intersect, creating a complex mechanical environment where both tensile stress and compressive stress act simultaneously.

2. Prognosis and Course of Sever’s Disease

Natural Course

Sever’s disease often naturally resolves as the growth plates close, and improvement can generally be expected with conservative approaches (activity restriction, stretching, orthotic therapy, etc.).

Typical Course

• Acute phase: 2-4 weeks of inflammatory period
• Subacute phase: 4-12 weeks of repair period
• Chronic phase: Several months to over a year in cases with prolonged symptoms

Factors Affecting Prognosis

Factors Indicating Good Prognosis

• Early appropriate intervention
• Improvement of systemic biomechanics
• Gradual return to activity

Poor Prognostic Factors

• Unresolved fundamental kinetic chain problems
• Inappropriate early return to activity
• Unimproved systemic posture and movement patterns

As a physical therapist with experience in many cases, I have realized that cases where only local approaches are used often result in repeated recurrences.

3. Comprehensive Osteopathic Approach

Integrative Assessment of Structure and Function

In osteopathy, based on the fundamental principle that “structure and function are interrelated,” we understand heel symptoms in a whole-body context.

Autonomic Nervous System Regulation

Parasympathetic Activation Growing children tend to have sympathetic nervous system dominance due to academic and sports stress.

Optimization of Kinetic Chain Through Structural Adjustment

Pelvic-Spinal Alignment Adjustment

Foot and Ankle Function Recovery

Integrative Myofascial System Approach

Superficial Back Line Adjustment

Deep Front Line Function Recovery

What Our Clinic Can Offer

1. Structural Adjustment

Whole-Body Alignment Assessment and Improvement

• Postural analysis and movement evaluation
• Integrated adjustment of pelvis-spine-cranium
• Lower extremity kinetic chain optimization

Foot Function Recovery

• Improvement of ankle range of motion
• Recovery of plantar arch function
• Gait pattern re-education

2. Release of Adhesions

Integrative Myofascial System Adjustment

• Superficial Back Line tension relief
• Deep Front Line function recovery
• Release of local fascial restrictions

Joint Mobility Improvement

• Inter-tarsal joint adjustment
• Knee-hip joint function improvement
• Whole spinal mobility enhancement

3. Self-Care Instruction

Graduated Exercise Program

• Acute phase: Pain management and inflammation reduction
• Recovery phase: Range of motion improvement and strength recovery
• Return phase: Sport-specific movement re-education

Daily Life Guidance

• Appropriate shoe selection
• Walking and running form improvement
• Home exercise instruction

Preventive Approach

• Exercise intensity adjustment according to growth stage
• Regular self-check methods
• Importance of early detection and intervention

In Conclusion

Sever’s disease pain tends to be overlooked as “inevitable during growth,” but looking only at the feet often causes us to miss the real underlying causes.

In osteopathy, we understand these symptoms not as localized problems but as changes in harmony during the whole-body growth process.

“The healing power lies within you”

Based on this belief, we help maximize the natural healing capacity and adaptive ability that growing children inherently possess.

By evaluating whole-body structure and integrating posture, nervous system function, and fascial line tension, we can achieve not only pain relief but also recurrence prevention and improved athletic performance.

Our clinic integrates specialized knowledge as physical therapists with osteopathy’s holistic approach, providing individualized treatment programs according to each child’s growth stage and characteristics.

If you have concerns such as “heel pain” or “quick recurrence even after resting from exercise,” please feel free to consult with us.

Through evidence-based evaluation and comprehensive support with your child’s healthy growth in mind, we will help ensure a worry-free growth period.

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For Those in Japan with Physical Discomfort

Are you unsure where to get care for pain or tension?
Worried about language barriers?

We offer gentle, hands-on osteopathy to support your body’s natural healing.

– Neck/shoulder stiffness from desk work

– Back pain or leg fatigue after travel

– Shin splints from walking/running

– Numbness in arms or legs

🤝 Still Learning English, but Here to Help
I’m still learning English,
but I study every day to support visitors and residents in Japan.

My English isn’t perfect, but I’ll listen carefully and respond with care.
I often use Google Translate—please don’t hesitate to contact me.

Sota Omura,
Qualifications: Licensed Physical Therapist / Master of Health Science

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