Pediatric Heel Pain
Symptoms, Causes and Treatment of Heel Pain in Children
The Most Common Causes of Heel Pain in Kids
Heel pain in children is not uncommon and can be caused by a few different issues. However, it is most likely due to Sever’s disease, Achilles tendinitis, a heel fracture, JIA, or Tendo-Achilles bursitis.
The most common cause of children’s heel pain between these is Sever’s disease. This overuse injury occurs most often in athletic children ages 7 to 15, but may occur as young as 5.
“90% of the heel pain cases we see and treat are due to Sever’s disease. The other 10% are due to other differentials. This is why it is so important to see a specialist that treats and resolved children’s heel pain every day. A lot of kids get misdiagnosed or undertreated for their condition and will either take longer to solve their issue or it does not get resolved and they live in chronic pain.”
– Dr. Mikkel Jarman
Children's Heel Pain Causes & Treatments
(We find that parents often dismiss a child’s heel pain as a normal part of growth. It is not. And, even though most heel pain is not a sign of something more serious, it should be evaluated by a pediatric podiatrist.)
Kid's Heel Pain Facts
1. 90% of the children seen for heel pain here at Pediatric Foot & Ankle is caused by Sever’s Disease.
2. The most common misdiagnosis for children’s heel pain is plantar fasciitis. Most of all of these cases prove to be Sever’s.
(Pediatric Foot & Ankle sees and treats dozens of children every month for heel pain, and in the past 9 years have had only one case of pediatric plantar fasciitis. The child was 16 year old and was successfully treated. So, it’s not impossible for children to get plantar fasciitis, but highly ulikely and very uncommon.)
3. The second most common cause of heel pain in children is achilles tendinitis.
4. A less common, but not unheard of cause of children’s heel pain, is juvenile idiopathic arthritis, formerly known as juvenile rheumatoid arthritis.
5. A pediatric podiatrist is the most qualified professional to diagnose and treat children’s heel pain and determine the best after care and prevention plan too.
The Most Common Cause of Children's Heel Pain
Sever's Disease (Calcaneal Apophysitis)
Sever’s disease, also known as calcaneal apophysitis, stems from a rapid growth spurt associated with childhood. As the heel bone grows at an accelerated rate, the surrounding muscles and tendons become stretched and inflamed due to this sudden growth spurt that the child has not yet adapted to yet.
Girls generally experience this growth spurt between 7 – 13 years old while boys will experience them around 10 – 15 years of age. Of course, this will depend on the individual children’s development rates.
Sever's Heel Pain in Kids who play Sports
Sports May Aggravate Sever's Disease
Active children, especially those engaged in sports, are more prone to heel pain due to a condition known as Sever’s Disease. This overuse injury, common in kids aged 7-15, results from the inflammation of the heel’s growth plate due to repeated stress from sports activities.
The Mikki Device offers a proven, effective solution for managing and treating this condition, allowing your child to continue enjoying their favorite sports.
Dr. Jarman's 2 Part Series on Sever's disease (7 minutes total)
Diagnosing Sever's disease
In this fist video of a two part series, Dr. Jarman shows how to identify whether or not your child’s heel pain might be Sever’s disease.
Treating Sever's disease
In this video, Dr. Jarman discusses the different treatment options for Sever’s and which option would be best for your child.
Symptoms & Diagnosis
Pain is generally felt at the back and either inner or outer side of the child’s heel, but sometimes on the bottom too. The pain will relieve when the child is not active but becomes painful with sports, especially “ground and pound” activities. Squeezing the sides of the heel bone will produce sharp or burning pain. Sever’s can affect one or both heels, and in severe cases the child will be limping.
Diagnosing Sever's disease
Dr. Jarman begins by taking the child’s medical history, paying special attention to activities they participate in, such as sports played. The physical exam includes gently squeezing the sides of the heel and having the child stand flat and then on tip-toe. Pain felt during any of these tests may indicate Sever’s disease, but further tests are done before just jumping to that conclusion.
The most definitive test is x-rays which are taken in office to rule out the possibility of foot fractures. High quality digital x-rays are taken in office and reviewed and shared during the first visit.
Treating Sever's Disease
Acute or Chronic?
Treatment depends on whether your child has acute or chronic Sever’s disease.
Acute treatment begins with resting the foot by reducing activities for one week. In many cases this is all that is needed, and the the child can resume activities starting off slow and working their way back up to full activities. Dr. Jarman may also recommend over-the-counter anti-inflammatory medications (i.e. ibuprofen). He will likely suggest a change in shoe gear as well which could include a reputable over-the-counter gel heel cup which he will help pick out based on your child specifically.
If acute care fails, Dr. Jarman begins treatment for chronic Sever’s disease. This includes correcting your child’s gait (how the foot hits the ground) and a custom orthotic to relieve pressure on the growth plate and stop the pain. In extreme cases, your child may require a CAM boot (Controlled Ankle Motion boot) to completely immobilize the foot for two to three weeks.
The Most Effective Treatment for Heel Pain Caused by Sever's Disease
For Either Acute or Chronic
Heel pain is the most common condition treated at Pediatric Foot & Ankle, and again, Sever’s disease is the most common cause. Dr. Mikkel Jarman, DPM, FACFAS has perfected what has proven to be the most effective treatment, even the harder to treat “Chronic” variation, which can be permanently resolved in 2 to 8 weeks. It is a combination therapy utilizing custom orthotics, a pediatric night time boot, and a correct schedule. Children are able to continue playing sports during the treatment, and get back to living their active lives with little to no restrictions.
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For Parents Out of State (or Country)
Introducing The Mikki Device™.
An at-home treatment option designed under the guidance of Dr. Jarman (and based on his in-office treatment), is now available to parents across the U.S. without a referral or doctor’s visit. Regardless of where you live, or whether a qualified pediatric podiatrist is available in your area, we believe parents should have access to this effective treatment.
(Learn more or order here)
Sever's Disease Custom Orthotic
The Mikki Device™
- At-Home Sever’s Treatment
- 97% Success Rate
- Doctor Visit Not Required
- Proven Results Within 6-8 Weeks
Real Life Experiences Shared by Patients and Parents
Gracie's experience with Severs
Ryan's experience with Severs
Other Causes of Heel Pain in Children
Other causes of pediatric heel pain include Achilles tendinitis and fracture.
Achilles tendinitis occurs when the tendon connecting the calf to the heel (the Achilles tendon) becomes inflamed. This typically happens after a sudden increase in activity, such as beginning a new sport. Achilles tendonitis treatment includes resting and elevating the foot as well as ice to relieve swelling. Dr. Jarman may also prescribe wrapping the foot to help support the Achilles tendon during activities.
Heel fractures and foot fractures may occur due to acute injury or repeated stress. They’re most common in children who play high-impact sports. Conservative treatment includes immobilizing the foot, rest, and medication to manage pain. Dr. Jarman may also prescribe physical therapy to return full function to the foot.
Juvenile Idiopathic Arthritis (JIA) is the most common type of arthritis in children and teens. It can cause joint pain and inflammation in the hands, writsts, elbows, and even knees and feet. JIA used to be called “juvenile arthritis” but the term wasn’t accurate since JIA is not a kid version of adult rheumatoid arthritis.
Pediatric Heel Pain FAQ's
The most common causes are plantar fasciitis, Achilles tendinitis, heel spurs, and Sever’s disease. Inflammation from overuse or injury is often the root cause.
Heel pain frequently affects active children around ages 8-14 as growth plates are still developing. However, it can occur at any age if predisposing factors are present.
Symptoms include pain and tenderness concentrated in the heel, especially with weight-bearing activity. Swelling, bruising, or redness may also be present. The pain usually lessens with rest.
A pediatrician or orthopedist will examine the child’s symptoms and medical history. Imaging like x-rays or MRI may be used to pinpoint issues like bone spurs or growth plate inflammation.
Rest, icing, over-the-counter anti-inflammatory medication, stretching, orthotic inserts, supportive footwear, and activity modifications are common early treatment approaches.
Surgery is very rarely needed for pediatric heel pain and only considered if significant disability persists despite exhausting non-surgical options over an extended timeframe.
Preventive steps include stretching the foot and ankle before activity, wearing proper athletic shoes, increasing training gradually, avoiding overuse damage, and correcting any biomechanical problems.
Yes, physical therapy is often an effective treatment for heel pain. PT focuses on flexibility, strengthening, balance training, massage, and modalities like ultrasound to promote healing.
With proper care, most cases of pediatric heel pain resolve within 2-6 weeks. But some stubborn cases can linger for several months, especially if activity is not modified.
It’s best to consult a doctor if heel pain in a child does not improve with a few days of rest. The doctor can assess severity, diagnose the source, and initiate proper management.