Heel Pain in Children

Calcaneal apophysitis (also known as Sever’s Disease) is an inflammation of the growth plate at the back of the heel bone.  This condition is usually seen in children around the ages of 8-12 years and usually coincides with growth of the foot.  Most children with calcaneal apophysitis will have a pain in the back of the heel which is often worse during or after physical activity (eg. football, soccer, running, etc.).

Most cases of calcaneal apophysitis are caused by excessive pulling of the achilles and plantar fascia tendons on the growth plate at the back and bottom of the heel.  The majority of children that get calcaneal apophysitis tend to have a foot type that flattens excessively during the gait cycle.  Increased physical activity causes the tendons in the foot to pull harder in an attempt to stabilize the pronation.  The excessive pulling, however, irritates and inflames the growth plate resulting in pain.  Calcaneal apophysitis can also be seen in children that have a naturally tight achilles tendon.  The tightness of the tendon can limit proper foot function causing an excessive pulling onto the growth plate.

What we can do to help your child

If your child is having heel pain, we would recommend that we see them as a patient.  Calcaneal apophysitis is something that your child will eventually out-grow, but there are many things we can do to treat this pain and allow them to continue to be as active as they want to be.

Initially, we will perform a complete history and physical examination of the feet to determine the cause of the heel pain.  We will perform a thorough biomechanical examination to determine what role their gait plays in the development of the calcaneal apophysitis.  We will also take digital x-rays to assess the growth plate and to rule out other causes of the pain.  We will help to educate you and your child on the proper shoe gear to wear to help with treatment and we will advise on certain activities to avoid to aggravate the problem.  It can be helpful to begin aggressive plantar fascia and achilles tendon stretching exercises to help with this condition and we can show you the proper techniques.  Sometimes it is necessary to rest from any activities that may be contributing to the pain.


The most important thing that we can do for your child is to fit them with the proper arch support or prescription orthotics.   If the heel pain is mild, we may be able to use a pre-made arch support to control the abnormal flattening of the arch.  We carry arch supports in our office that are typically much better than what you will find in the store.  Some cases of calcaneal apophysitis are more severe and may require the use of a prescription orthotic.  This is a custom-made arch support that is made from a plaster impression or digital scan of the foot and arch.  Unlike pre-made arch supports, however, an orthotic completely controls abnormal pronation or flattening of the arch and completely removes pulling of the plantar fascia and the achilles tendon on the growth plate.  Read more about custom orthotics.  

Most cases of calcaneal apophysitis are easily treatable with these simple measures.  The doctors at Council Bluffs Foot & Ankle Care are experts in the treatment of this condition.  Our goal is to get your child back into the game as soon as possible. 

320 McKenzie Ave., Ste. 102

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