Heel pain in children (Sever’s disease)
The most common heel pain between 8 and 14. It appears with sport and usually settles when the load is reduced.
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?
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