Heel pain is not uncommon in children, and can make sports and other activities difficult to participate in. The cause of most heel pain in children differs somewhat from heel pain in adults, and is therefore treated a little differently. This article discusses the nature of heel pain in children, and how it can be relieved.

Heel pain is common across all age groups and activity levels. In adults, this pain is usually caused by inflammation of a ligament on the bottom of the arch called the plantar fascia. Commonly referred to as a heel spur since a bone spur sometimes accompanies this condition (although the spur itself is not the source of pain), this painful injury is usually caused by abnormal foot structure straining the arch tissue. It is commonly found in those with flat feet, high arches, or those who work on ladders or stairs frequently. Treatment involves reducing the inflammation with medicine, stretching the arch, and supporting the foot structure with shoe inserts. Some children can also get this condition, particularly if they are flat footed or are obese. However, the majority of the time, heel pain in children is caused by a natural process that affects the growth plate in the heel bone (calcaneus).

As humans grow, the bones become longer and wider. Although some foot bones initially develop from cartilage molds before birth, the majority the foot bone size develops from growth plates found within each bone. These growth plates are soft areas found at one end of the bone or the other, and are set up to produce bone like a factory, constantly pushing bone out in a direction away from the growth plate. This effectively lengthens and widens the bone. Eventually, in the late teen years, this growth stops and the growth plates themselves fuse into bone. In the heel bone, the growth plate is located along the bottom back of the bone, where the heel bone is rounded to form the 'ball' of the heel. Sometime in late childhood to the early teen years, inflammation and swelling can begin to develop in the growth plate region. Not every child experiences this condition, also known as Sever's disease. It can develop on its own without injury or overactivity, although chronic repetitive stress can have a role. Girls seem to develop it earlier, presumably because of earlier growth activity. There is no inherent problem with the growth plate during this process, and growth continues uninterrupted. The inflammation continues until it runs its course, although continued athletic activity during this time prolongs the inflammation. From a physiological perspective, the inflammation can technically continue until the growth plate fuses into bone in the late teen years, although it is uncommon for this condition to last so long. However, most kids suffer through the discomfort for several months at least.

The symptoms of this condition are fairly specific. The pain begins with walking, running, or standing for awhile. It is located along the bottom back part of the heel, and may include some pain traveling up the Achilles tendon. Arch pain can sometimes be felt, but this has more to do with irritation of the arch due to limping from the heel pain than from the growth plate pain itself. Skin swelling, warmth, redness, or other external signs of this inflammation are rarely seen. The child with this condition will have difficulty participating in sports or other activity due to the pain, but usually will persist with that activity since the pain is rarely severe enough to outright prevent them from staying active. Unfortunately, this will only prolong the condition. The Achilles tendon also plays a role in this condition. Since the Achilles tendon attaches to the heel bone along the near side of the growth plate, any tightness in this tendon can exert excessive pressure on the growth plate. The pressure, which essentially is extra traction on the back of the growth plate, causes further inflammation and irritation. On rare instances, the growth plate itself may not be inflamed from a natural process but rather from an injury that has caused a fracture. Growth plate fractures in the heel bone are rare, but do occur. Causes can include a fall from a moderate height as well as a hard kick backwards onto a firm object.

Treatment centers around supporting the inflamed growth plate and allowing it to settle down on it's own. Rest from running and other impact activities is vital, and may be necessary for weeks to months. Icing the heel several times a day helps, as do over-the-counter children's medications like ibuprofen. Heel stretching will relieve any traction the Achilles tendon will place on the heel bone itself, and the use of inserts with a deep heel cup can control heel pressure and side to side motion in shoes. Unfortunately, it is this author's experience to see many kids with this condition who participate in year round sports, and who will not reduce their activity to allow this condition to resolve. Sometimes it is because the parents are not forceful enough in enforcing the rest period in kids that don't want to stop activity, and sometimes it is the parent's refusal to keep their kids out of sports temporarily out of some misguided need to keep their kids 'fresh in the game'. Regardless, the reality of the situation is simple: most children are not world-class athletes whose fame and fortune rests on continuing in the sport, and they certainly don't have professional athletic trainers and therapists at their disposal each game dedicated to getting them through the pain. Taking a few months off is not going to adversely effect their future. Parents and children need to take a step back and realize that this condition needs to be rested, as it can potentially linger into the late teen years where the potential to participate in collegiate athletics can definitely be effected.

It should be noted as well that this condition can potentially return after it resolves if the growth plate has not yet fused. Although less common, repeated bouts of the inflammation are possible, especially in very active children.

Although this condition is generally treated easily at home, and although growth plate inflammation is usually at fault to begin with, there is a possibility that the heel pain can be due to a another reason. As mentioned earlier, fractures do occur, though rare, and other injuries around the heel region can mimic this growth plate inflammation. At times, heel pain can have complicated causes, some of which can include nerve damage or may indicate diseases elsewhere in the body. A proper evaluation by a foot specialist can determine the true cause of the condition, and will ensure the best treatment course possible for the underlying cause. Even if a parent simply concludes that their child's heel pain is due to the growth plate based on this and other internet articles, a foot evaluation by a podiatrist is recommended to be absolutely certain. With proper care, growth plate inflammation can be easily resolved, and, if there are other conditions present, long term problems can be avoided if early medical intervention is given.