Heel pain in children is often due to Severs Disease, or its proper name, calcaneal apophysitis, which is a common and painful condition experienced by growing children. The site of the pain is the calcaneal epiphysis. This is the heel bone’s growth plate and the Achilles tendon’s attachment. Pain is felt in the back of the heel, and in some cases, there may be pain that “wraps” around the heel, ending on the bottom of the foot near the beginning of the arch of the foot. Pain can make it difficult to walk or cause the child to limp, and sports or activities involving running and jumping will worsen the pain but will subside when activities are stopped. Some shoes may also worsen the pain due to pressure on the sore heel. This condition is most common in children between 10 and 14 years of age. It is very similar to Osgood-Schlatters Disease seen in the knee.  

Due to the rapid growth 10—to 14-year-olds experience, muscle flexibility, particularly tight calf muscles, can exacerbate symptoms by adding to the shearing forces on the heel growth plate. Children who walk with a pronated foot can also increase the shearing forces on the growth plate, increasing pain.

Ice the affected area daily, even on days when the pain is not extreme, to reduce the inflammatory cycle and overall pain. Ice should be applied for 20 minutes at least once per day.

Stretch the calf muscles gently and Hold the stretch for 10 to 15 seconds three times. This should be repeated up to 10 times daily.  

Heel lift in shoes that raises the heel effectively lengthens the Achilles tendon, reducing stress. Keep in mind that if a heel lift is used, stretching becomes more important to counteract any physical shortening of the tendon that may occur.

Reduce sporting activities as pain allows. If it hurts, rest and ice, then return to play when the pain allows.

Shoes with a cushioned heel as one of the most painful things is impact on the heel. If the child does not wear shoes, the chances of impact on the sore area increase. Soccer and football boots often have no heel or cushioning, so look for boots that do or add in a heel lift. If pronation is present, cushioned

Orthoses to control the amount of rolling if pronation is present, and therefore, shear force on the growth plate will help.

Severs Disease is usually self-limiting and will go away when rapid growth ceases. It does not predispose to any long-term problems later on in life. In very few cases will a child need to be removed from all sporting activities; most will be able to continue to participate in sport with modifications.