Heel Pain in Children: Causes, Symptoms, and Treatment Options

Heel pain, or “pediatric heel pain,” is a common condition that affects children and adolescents, particularly those who are physically active. Often referred to as Sever’s disease (Sever-Blanke-Haglund disease), this condition involves the growth plate of the heel bone (calcaneus), specifically its lower rear portion. It’s especially prevalent among young athletes and requires careful attention from parents, coaches, and healthcare professionals.

Understanding the Mechanism and Causes

Heel pain in children is closely linked to periods of rapid growth. During development, bones can grow faster than the surrounding muscles and tendons, creating abnormal tension in the heel area. This imbalance often leads to painful inflammation, especially during or after physical activity.

Several factors contribute to the onset of heel pain in children:

1. High-impact sports: Activities like soccer, gymnastics, and dance involve running, jumping, and quick changes of direction—all of which increase the stress on the heel.
2. Inappropriate footwear: Shoes lacking proper cushioning or support can heighten pressure on the heel during movement.
3. Excess body weight: Being overweight puts additional strain on the heel bone, making inflammation more likely.
4. Growth spurts: Rapid growth periods can worsen the imbalance between bone length and soft tissue flexibility.
5. Foot biomechanics: Structural or functional abnormalities in the foot can contribute to heel stress and pain.

Recognizing the Symptoms

Heel pain in children usually appears during or after physical activity. Typical symptoms include:

• Pain localized at the back or underside of the heel, which worsens during walking or sports
• Increased pain when standing on tiptoes
• Swelling and redness around the heel
• Difficulty walking normally in more severe cases
• Possible cracking or signs of skin irritation over the heel

Symptoms can range from mild discomfort to more intense pain, significantly affecting a child’s quality of life and participation in daily or athletic activities.

Prevalence in Soccer and Other Sports

Soccer is one of the leading causes of heel pain in children under 12 due to the repetitive stress placed on the feet and ankles during training and matches. Studies on young soccer players aged 8 to 12 have shown that over 31% reported heel pain, and 14% experienced both heel and knee pain at the same time.

These figures highlight the need for proper management of training intensity and sports equipment in young athletes. Other sports that involve frequent jumping or sharp foot movements—such as gymnastics, track and field, or dance—also require special care to prevent heel issues in children.

Effective Prevention Strategies

Prevention is key in managing pediatric heel pain. Several proven strategies include:

1. Wearing proper footwear: Choose shoes with good shock absorption and proper arch support. Footwear should be specific to the sport and replaced regularly to maintain effectiveness.
2. Monitoring training intensity: Adjusting the frequency and intensity of physical activity—especially at the first signs of discomfort—can prevent worsening of the condition.
3. Using heel cushions: Special insoles or heel cups can provide extra support, reduce stress on the heel, and improve balance and posture during movement.
4. Stretching exercises: Including stretches for the Achilles tendon and calf muscles in the child’s routine can reduce tension and strain on the heel.
5. Maintaining a healthy weight: Helping the child stay within a healthy weight range can ease the load on the feet and lower limbs.
6. Education: Teaching children, parents, and coaches to recognize early symptoms and manage sports participation properly is crucial for effective prevention.

Treatment Approaches

Once heel pain develops, several treatment options can help:

• Rest and activity modification: Reducing or temporarily stopping the activity that causes pain allows the inflamed tissues to heal and relieves heel pressure.
• Ice therapy: Applying ice packs to the painful area for 15–20 minutes multiple times a day can ease inflammation and discomfort, especially in the early stages.
• Stretching and physical therapy: A guided exercise program supervised by a physiotherapist can improve flexibility and strengthen the affected muscles and tendons.
• Orthopedic supports: Silicone heel cups or other shock-absorbing inserts can provide immediate relief and help prevent recurrence. These devices distribute pressure more evenly and reduce impact during walking and sports.
• Physical therapies: In some cases, ultrasound therapy or laser treatments may be used to reduce inflammation and promote tissue healing.
• Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to manage pain and inflammation, but only under medical supervision.

When to Consult a Specialist

It’s important to seek medical advice when:

• Pain is severe or persists despite rest and conservative care
• There’s noticeable swelling or redness in the heel
• The child struggles to walk normally
• Symptoms last for more than a few weeks
• There’s a possibility of another underlying condition or complication

A thorough orthopedic evaluation may include diagnostic imaging, such as X-rays or ultrasounds, to rule out other causes and create a personalized treatment plan.

Conclusion and Future Perspectives

Although heel pain in children is generally benign and temporary, it requires careful attention and a multidisciplinary approach. Prevention through proper sports practices and orthopedic support remains the most effective strategy. When symptoms arise, timely and appropriate treatment helps ensure a quick recovery and prevents long-term issues.

Ongoing research in pediatric biomechanics and sports medicine continues to offer new insights for the optimal management of heel pain in young athletes. The goal is to help children enjoy the benefits of physical activity while minimizing the risk of injury and supporting healthy development.

For parents, coaches, and healthcare providers, the challenge is to balance a child’s enthusiasm for sports with the need to protect their musculoskeletal health. An informed and collaborative approach can make a real difference in preventing and effectively treating heel pain—allowing children to safely continue the activities they love.

For more information, visit us at Ortopedia in Via Taramelli 21/23, Bergamo.

You can reach us at +39 035 212110 from Monday to Saturday, 9:00–12:30 and 15:00–19:00, or contact us by email at info@ortopediazambelli.it.