Sever’s Disease (Calcaneal Apophysitis) – Heel Pain in Children

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Children’s heel pain is different than adult heel pain although the cause may be the same. The juvenile version of plantar fasciitis occurs in girls and boys below the age of 14. Progressing pain is found around the outside portion and back of the heel. This area will be tender at the beginning as well at the end of activity. There is usually mild to moderate improvement in comfort during activity. There can be extraordinary discomfort in the back of the heel when it is bumped on a hard surface. Symptoms generally present towards the end of the sports season or when going directly from one sport to another, such as soccer to basketball, where there is little rest or recovery.

Although the same foot mechanics and Achilles tendon tightness is present in both the adult and adolescent heel pain, the difference for kids is their bone growth center (apophysis) at the back of the heel (calcaneus). This will produce different symptoms with youngsters. A tight Achilles tendon will be noticeable when you watch the child walk. There will be a distinct “bouncy” gait when the heel comes off the ground early. The foot may also roll in (or pronate) a great deal.

You Can Tell by the Way They Walk

Watch your child walk away from you without shoes or socks on and observe the Achilles tendon. Look for a bending or bowing of the Achilles tendon away from the midline of the body. This is rear foot pronation. When watching the child walk towards you, look for a dropping of the arch and a bulge in this area. Now watch the parents and grandparents walk – you will  know who to blame for this problem. There is a strong hereditary influence for the mechanics of the foot, and the apple does not fall far from the tree.

Rest will help this problem, but unfortunately the discomfort will return with activity. The treatment for this is very similar to the adult version – both the mechanics of the foot and tightness of the Achilles tendon must be addressed.

For Children’s Heel Pain, Sooner Treatment is Better

The great advantage of youth is that the connective tissue will change much quicker than an adult and flexibility will provide relief much sooner (7 – 14 days). Another great advantage for a growing child is their bones are soft and can be changed with time if they are held in a better position. The earlier the bad mechanics can be addressed in a child, the greater potential there is to change the bone structure without aggressive surgery. Once the growth center has completed its job it will disappear and the peripheral heel pain will go away, but the adult version is not far away.

Do you have children 6-14 years old? Does this sound familiar? Contact the Indianapolis office of Jeffrie C. Leibovitz, D.P.M. at (317) 545-0505. We will ensure the right treatment for your child and his or her active lifestyle.


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Indianapolis, IN 46216

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