Pediatric Flat Feet & Sever’s Disease in Children | Michigan Podiatrist

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

Pediatric flat feet are normal in children under age 6 and do not require treatment unless they cause pain, fatigue, or gait abnormality. Sever’s disease (calcaneal apophysitis) is the most common cause of heel pain in children ages 8–14, caused by traction stress on the growth plate from tight calf muscles during periods of rapid growth. Dr. Tom Biernacki, DPM at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan evaluates and treats both conditions, providing parents with accurate guidance on when watchful waiting is appropriate and when intervention is needed.

Pediatric Flat Feet: When to Be Concerned

All infants and toddlers have flat feet — the arch develops between ages 3 and 6 as the musculature and ligaments mature. A flat arch in a child under 6 who is walking normally and has no pain requires no intervention. Flexible flat feet (arch appears when the child stands on tiptoe) in an older child without symptoms is a normal variant, not a pathological condition. Intervention is warranted when flat feet cause persistent pain or fatigue with walking, when the deformity is rigid (arch does not form on tiptoe), when one foot is flatter than the other (possible tarsal coalition), when there is progressive worsening, or when the child is developing secondary problems such as shin splints, knee pain, or hip pain from altered gait mechanics.

Sever’s Disease: The Most Overlooked Cause of Children’s Heel Pain

Sever’s disease is not actually a disease — it is a painful overuse condition of the calcaneal apophysis (growth plate at the back of the heel bone). The Achilles tendon and plantar fascia both attach near this growth plate. During rapid growth spurts in children ages 8–14, the bones elongate faster than the soft tissues, creating traction stress on the growth plate during activity. Running, jumping, and sports participation aggravate the condition. Symptoms include heel pain that worsens with activity and improves with rest, tenderness on squeezing the sides of the heel (positive squeeze test), and tip-toe walking to offload the painful heel.

Diagnosing Sever’s Disease vs. Other Conditions

Sever’s disease is a clinical diagnosis based on age, activity history, heel pain pattern, and the squeeze test. X-rays are obtained to rule out stress fracture and to confirm the open growth plate, but the fragmented appearance of the calcaneal apophysis on X-ray is a normal developmental finding and does not diagnose Sever’s on its own. Differential diagnoses include calcaneal stress fracture (more focal point tenderness, positive tuning fork test), plantar fasciitis (uncommon in this age group, different pain pattern), and Achilles tendinopathy (posterior rather than inferior heel tenderness).

Treatment for Pediatric Flat Feet

For symptomatic pediatric flat feet, the first intervention is supportive footwear with a firm heel counter and arch support. Custom orthotics are indicated for children with painful flatfoot that does not respond to supportive shoes, progressive deformity, or flat feet contributing to secondary lower extremity problems. Orthotics in children typically require replacement every 12–18 months as the foot grows. Physical therapy addressing posterior chain flexibility (gastrocnemius, soleus, hamstrings) improves arch mechanics independently of structural support. Surgery is rarely needed in children and is reserved for rigid flatfoot from tarsal coalition or severe progressive deformity that is symptomatic and not responding to conservative care.

Treatment for Sever’s Disease

Sever’s disease resolves when the growth plate fuses — typically by age 14–15. In the meantime, activity modification reduces traction stress during symptom flares. Heel lifts or heel cups reduce tension on the calcaneal apophysis during gait. Calf stretching and eccentric strengthening are the most important therapeutic exercises. Custom orthotics with heel lifts built in are beneficial for children with underlying flatfoot contributing to increased Achilles tension. NSAIDs (age-appropriate dosing, short courses) are helpful during severe flares. Complete rest is rarely required — the goal is activity modification to a pain-free level, not cessation of all sports.

Most Common Mistake in Treating Children’s Heel Pain

The most common mistake is dismissing Sever’s disease as “growing pains” and advising the child to push through it. While the condition is self-limiting, continuing high-impact activity through significant pain prolongs recovery and reduces sports participation time. The correct approach is temporary activity modification to a pain-free level, heel lifts, calf stretching, and return to full activity as symptoms allow — not through-pain continuation or complete rest.

When to See a Podiatrist for Your Child

Bring your child to a podiatrist if heel or foot pain has lasted more than 2 weeks, if pain is severe enough to cause limping or affect daily activities, if one foot appears more deformed than the other, if the child is toe-walking to avoid heel contact, or if you are uncertain about the diagnosis. Dr. Biernacki evaluates pediatric patients from infancy through adolescence and provides age-appropriate treatment plans that keep children active while addressing foot health. Schedule an appointment or call (810) 206-1402 — Howell and Bloomfield Hills, Michigan.

Pediatric Foot Specialist in Michigan

Children’s foot conditions like flatfoot and Sever’s disease require specialized pediatric podiatric care. Our doctors provide gentle, expert treatment to keep your child active and pain-free.

Learn About Our Pediatric Foot Care → | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Halabchi F, Mazaheri R, Seif-Barghi T. “Patellofemoral pain in athletes.” Sports Medicine. 2017;47(8):1469-1483.
2. James AM, Williams CM, Haines TP. “Effectiveness of footwear and foot orthoses for calcaneal apophysitis (Sever’s disease).” British Journal of Sports Medicine. 2016;50(16):988-996.
3. Pfeiffer M, Kotz R, Ledl T, et al. “Prevalence of flat foot in preschool-aged children.” Pediatrics. 2006;118(2):634-639.

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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.