Between eight and fourteen, the heel bone still has a growth cartilage at the back, exactly where the Achilles tendon attaches. When that point is overloaded it becomes irritated, and that produces the most common heel pain at that age —calcaneal apophysitis, or Sever’s disease—: it hurts when running and jumping, improves with rest, and often the child starts walking on tiptoes without realising, to avoid loading the heel.
It is more common in children doing sport with lots of push-off and braking —football, basketball, athletics—, during fast growth spurts, and with unsupportive footwear. It leaves no lasting damage: it resolves as the cartilage matures. In the meantime the aim is that the pain does not force them to stop moving, and for that the load on that point has to come down without taking the activity away all at once.
What is done
- Confirming that the pain is in the heel and not in another structure.
- Reviewing sporting activity: how many days, on what surface and in what footwear.
- Assessing the tightness of the Achilles tendon and of the calf muscles.
- Cushioning and offloading the heel so the child can keep moving.
- Adjusting the load with the family and reviewing progress.
Does your child’s heel hurt when playing or training?
Book an appointmentFrequently asked questions
- Do they have to stop playing sport?
- Almost never completely, and stopping abruptly usually goes badly: for a child that age sport is not just another activity, it is where their friends are, and a complete withdrawal takes away far more than the training. What works is adjusting the load: reducing days or intensity for a while, dropping the highest-impact parts for now — jumps, sprints, hard stops — and keeping whatever does not hurt, while cushioning and offloading the heel. That is decided with you and with what the child reports, and it gets reviewed: if pain eases when load comes down, it is built back up; if it does not ease, it needs reassessing rather than persisting.
- Why now, if they have always played the same?
- Because what has changed is not the sport, it is the bone. At these ages the heel has an active growth zone exactly where the Achilles tendon pulls, and that zone is sensitive to repeated load while it is maturing. If the child is also in a growth spurt, the bones grow before the muscles adapt, so the tendon pulls harder than usual on a point that is already sensitive: the very same activity becomes too much. That is why it appears without anything having changed on the outside, and why it resolves as that zone matures. What is done meanwhile is reducing the tension on that point so they can keep playing.
