What can cause heel pain in children?

Heel pain in children is actually quite common. There is a condition that affects the back of heel bone in children called Sever’s disease that a lot of children get. It is a growth plate issue, so for that reason it is something that the child will outgrow eventually. It is important to understand that this is not a disease, but the name is something that has stuck so it is still widely used. The more appropriate name is calcaneal apophysitis. There is a growth plate (the apophysis) at the back of the heel bone where growth happens, so the condition is an injury to that growth plate. It generally affects children between the ages of around 10-12 years of age, with some affected outside those ages. When growth in the heel bone finishes around the middle of the teenage years, then Sever’s disease is no longer a problem or issue.

The diagnosis of Sever’s disease is usually straight forward and is based on the age of the child and the symptoms. There is nothing that can be seen on x-ray or other imaging, so these are a waste of time to get a diagnosis. The pain is normally worse on exercise. The pain is generally at the sides and back of the heel bone and can be more painful if you squeeze the side of the heel bone. The symptoms do typically tend to fluctuate from week to week. The cause of Sever’s disease is simply too much use, so it is more common in children that are more active or have a heavier body weight as this simply puts more pressure on the heel bone and overloads it. If the ground that the child plays sports on is harder, then this may be a factor. Some think that tight calf muscles may also be an issue, but other experts do not think that it is a problem.

The treatment of Sever’s disease is mostly just taking it easy until the symptoms improve. Exercise levels should be dictated by how much pain there is and managing that. If the pain is getting better, then activity levels can be increased. If the pain is getting worse then activity levels should be reduced. This means that the child and parents need to be educated in the self-limiting nature of this condition and how to manage the loads to keep the pain under control over time. The most common treatment for this is typically a cushioning heel pad that protects the heel from hard impacts on the ground and from the pull of the Achilles tendon. If the pain is particularly bad, then strapping can be used to limit movement and ice can be applied to help with the pain after sports activity. If the foot is particularly flat or overpronated, then foot orthotics are sometimes used to help that along with the heel pain. The biggest challenge is always to convince that child to reduce activities when the pain is bad as their natural instinct is to be as active as possible.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.