Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Heel pain in a growing child is one of the most common complaints seen in pediatric podiatry — and one of the most mishandled. While adults almost always have plantar fasciitis, children have a completely different anatomic reason for heel pain: Sever’s disease (calcaneal apophysitis). At Balance Foot & Ankle, Dr. Tom Biernacki has extensive experience diagnosing and treating heel pain in children and adolescents throughout Southeast Michigan.

What Is Sever’s Disease?

Sever’s disease is not actually a disease — it is an apophysitis, meaning inflammation at the growth plate of the heel bone (calcaneus). In growing children, the growth plate (apophysis) is the weakest point of the heel bone, softer than the surrounding mature bone. The Achilles tendon inserts at the back of the calcaneus just above the apophysis. During rapid growth spurts, the bones grow faster than the muscles and tendons, creating traction stress at the growth plate with every step. Repetitive loading — especially in sports involving running and jumping — inflames the apophysis, causing characteristic posterior and inferior heel pain.

Who Gets Sever’s Disease?

Sever’s disease is most common in children between 8 and 14 years of age, with peak incidence at age 10–12. It is more common in boys and in children who are highly active in sports — soccer, basketball, gymnastics, cross country, and football are the highest-risk activities. Flat feet (overpronation), high arches, tight calf muscles, rapid height gain, and playing on hard surfaces (concrete, artificial turf) all increase risk. It is almost always bilateral (both heels) though one side may be more symptomatic.

Diagnosis

The diagnosis is clinical. The medial-lateral squeeze test of the posterior heel (compressing both sides of the calcaneus simultaneously) reproduces pain reliably. X-rays may show apophyseal fragmentation — but this is a normal radiographic variant in this age group and should not be over-interpreted. MRI is reserved for atypical cases where stress fracture, calcaneal fracture, or bone tumor must be excluded.

Treatment

First-line treatment is activity modification, heel cushion inserts (heel cups), and a structured calf and Achilles stretching program. The goal is to reduce traction stress at the apophysis. Ice after activity reduces inflammation. Over-the-counter anti-inflammatories (ibuprofen) may be used short-term with parental guidance. In more severe cases, a period of protected weight-bearing in a walking boot for 2–4 weeks allows the inflammation to settle. Custom orthotics address concurrent flatfoot or high arch biomechanics that increase load. Corticosteroid injections are not recommended at the pediatric heel growth plate. Sever’s disease is self-limiting — once the growth plate closes (typically by age 15–16), the condition resolves entirely.

Other Causes of Heel Pain in Children

While Sever’s disease accounts for the majority of pediatric heel pain, other diagnoses must be considered: Achilles tendinopathy (in older adolescents with closed growth plates), plantar fasciitis (in teenagers with adult-type biomechanics), calcaneal stress fracture (in distance runners or gymnasts), retrocalcaneal bursitis, and rarely, calcaneal tumors (benign unicameral bone cysts or, very rarely, malignant lesions). Dr. Biernacki evaluates each child comprehensively to ensure the correct diagnosis drives the treatment plan.

Frequently Asked Questions

Heel pain shouldn’t keep your child on the sidelines. Contact Balance Foot & Ankle for a pediatric heel pain evaluation with Dr. Biernacki in Southeast Michigan.

Heel Pain in Children — When to See a Podiatrist

Growing pains in the heel (Sever’s disease) are common in active children. Our pediatric foot specialists provide gentle, effective treatment.

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Clinical References

1. Scharfbillig RW, et al. Sever’s disease: a systematic review of treatment options. J Foot Ankle Res. 2008;1(Suppl 1):O38.
2. James AM, et al. Effectiveness of footwear and foot orthoses for calcaneal apophysitis. Br J Sports Med. 2016;50(16):988-997.
3. Hendrix CL. Calcaneal apophysitis (Sever disease). Clin Podiatr Med Surg. 2005;22(1):55-62.

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.