The most likely cause of heel pain in girls between 8-11 and boys between 8-13 is calcaneal apophysitis (1) or inflammation of the growth plate of the heel bone as it continues to grow.
Despite what many adults think, because of the high percentage who experience heel pain at some point, chances are very good that it is not plantar fasciiosis as this diagnosis is highly unlikely in children. (2)
Signs and Symptoms:
A key symptom is that your child will complain of heel pain AFTER activity and/or as they try to fall asleep rather than upon taking the first few steps in the morning.
This most often occurs in active boys who may also be gaining a bit of weight as they approach puberty.
Very active girls can also be affected.
Children with this condition will be the same as their asymptomatic peers in terms of mobility and overall foot appearance. (3)
Your child may limp or walk on their tip-toe to avoid heel contact with the ground.
Squeezing the heel from side-to-side will elicit discomfort.
What should parents do?
Confirm your suspicion of calcaneal apophysitis with your family MD
Consult with a foot care professional to rule out any biomechanical issue that may be additive to your child’s symptoms. Poor foot biomechanics can contribute to foot pain.
Encourage use of orthopaedic sandals (ie. Birkenstocks) instead of socks or soft slippers around the house.
Use properly sized, sport-specific shoes
Speak with your child’s coach if they are functioning at a “rep-level” about curtailing some running training while the pain is acute.
The fact of the matter is that most young athletes can safely eliminate a month of aerobic training without any negative effect.
Consider having them do interval training consisting of sit-ups, push-ups, burpees etc. while other team members run laps of the field.
This recess from running and focus on core/upper body work may actually serve to improve performance.
Typically symptoms last several weeks to 2 months and can recur several times over a few years until your child’s heel stops growing.
It’s a small consolation to a child in pain but you can tell them each time it happens, their feet are growing! Most kids want to get bigger and this is unfortunately one of the prices to pay for growth!
1. Duong MM, Nicholson AD. Relationship Between Sever Disease and Skeletal Maturity. J Pediatr Orthop. 2018 Feb epub
2. Tu P.Heel Pain: Diagnosis and Management. Am Fam Physician. 2018 Jan 15;97(2):86-93.
3. McSweeney SC, Reed L, Wearing S. Foot Mobility Magnitude and Stiffness in Children With and Without Calcaneal Apophysitis.Foot Ankle Int. 2018 Jan
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