Pediatric Heel Pain

Heel pain is a symptom warning that a child has a condition that deserves attention. Heel pain problems in children are often associated with pain in the back or bottom of the heel, Limping, and or walking on toes. The most common cause of pediatric heel pain is a disorder called calcaneal apophysitis (see below), which usually affects 8– to 14–year old's. However, pediatric heel pain may be the sign of many other problems and can occur at younger or older ages. 

Pediatric heel pain differs from the most common form of heel pain experienced by adults (plantar fasciitis) in the way pain occurs. Plantar fascia pain is intense when getting out of bed in the morning or after sitting for long periods, and then it subsides after walking around a bit. Pediatric heel pain usually doesn’t improve in this manner. In fact, walking around typically makes the pain worse. 

Heel pain is so common in children because of the very nature of their growing feet. In children, the heel bone (the calcaneus) is not yet fully developed until age 14 or older. Until then, new bone is forming at the growth plate (the apophysis), a weak area located at the back of the heel. Too much stress on the growth plate is the most common cause of pediatric heel pain.

What are the causes of pediatric heel pain? 

• Calcaneal Apophysitis Also known as Sever’s disease is the most common cause of heel pain in children. Although not a true “disease,” it is an inflammation of the heel’s growth plate due to muscle strain and repetitive stress, especially in those who are active or obese. This condition usually causes pain and tenderness in the back and bottom of the heel when walking, and the heel is painful when touched. It can occur in one or both feet.

• Tendo–Achilles bursitis. This condition is an inflammation of the fluid-filled sac (bursa) located between the Achilles tendon (heel cord) and the heel bone. Tendo–Achilles bursitis can result from injuries to the heel, certain diseases (such as juvenile rheumatoid arthritis), or wearing poorly cushioned shoes.

• Overuse Syndromes. Because the heel’s growth plate is sensitive to repeated running and pounding on hard surfaces, pediatric heel pain often reflects overuse. Children and adolescents involved in soccer, track, or basketball are especially vulnerable. One common overuse syndrome is Achilles tendonitis. This inflammation of the tendon usually occurs in children over the age of 14. Another overuse syndrome is plantar fasciitis, which is an inflammation of the band of tissue (the plantar fascia) that runs along the bottom of the foot from the heel to the toes.

• Fractures. Sometimes heel pain is caused by a break in the bone. Stress fractures — hairline breaks resulting from repeated stress on the bone — often occur in adolescents engaged in athletics, especially when the intensity of training suddenly changes. In children under the age of 10, another type of break — acute fractures — can result from simply jumping 2 or 3 feet from a couch or stairway.