Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
The most important clinical decision with Heel Pain in Children: Sever’s Disease, Causes & Treatment isn’t which treatment to choose — it’s identifying which subtype you have first. Our podiatrists see patients treated for the wrong subtype for months before the correct diagnosis leads to full resolution. Call (810) 206-1402 — expert podiatric care across Michigan.
Heel pain in children is rarely the same condition as adult heel pain. While plantar fasciitis dominates adult heel pain presentations, the most common cause in children aged 8–14 is Sever’s disease (calcaneal apophysitis)—inflammation at the growth plate of the heel bone where the Achilles tendon and plantar fascia both insert. Understanding which condition is causing your child’s heel pain determines the correct treatment and the realistic timeline for return to sport.
At Balance Foot & Ankle in Howell and Bloomfield Hills, MI, we evaluate pediatric heel pain with clinical examination and, when needed, X-ray to assess growth plate maturation and rule out stress fracture or other bony pathology.
Causes of Heel Pain in Children by Age
| Condition | Peak Age | Key Features | X-Ray Finding |
|---|---|---|---|
| Sever’s disease (calcaneal apophysitis) | 8–14 (boys); 8–13 (girls) | Bilateral in 60%; pain at heel sides/back during/after sport; squeeze test positive; worsens with growth spurts | Fragmented, sclerotic apophysis (normal variant—diagnosis is clinical) |
| Plantar fasciitis | Rare in children; more common teens with high BMI or flatfoot | First-step morning pain under heel; improves with walking; rare under age 10 | Occasionally heel spur (uncommon in children) |
| Calcaneal stress fracture | Any age; active adolescents | Insidious onset; worsens with activity; positive squeeze test; recent mileage increase | Periosteal reaction; MRI if X-ray negative with high suspicion |
| Retrocalcaneal bursitis | Adolescents wearing stiff shoes | Swelling and tenderness at back of heel (between Achilles and calcaneus) | May show soft tissue swelling; Haglund’s deformity if chronic |
| Achilles tendinopathy | Adolescent athletes | Mid-portion Achilles tenderness; stiffness after rest; thickened tendon | Normal; MRI for intratendinous changes |
| Juvenile idiopathic arthritis (JIA) | Variable; may present at any pediatric age | Bilateral; morning stiffness >30 minutes; other joint involvement; elevated inflammatory markers | Periarticular osteopenia; referral to pediatric rheumatology |
Sever’s Disease: What Parents Need to Know
Sever’s disease is not actually a disease—it is a traction apophysitis (irritation of the growth plate) caused by the Achilles tendon and plantar fascia pulling on the calcaneal apophysis, the secondary ossification center at the back of the heel bone. During growth spurts, bones lengthen faster than muscles and tendons; the tightened Achilles tendon exerts increased traction on the growth plate with every heel strike and push-off, causing inflammation and pain.
The diagnosis squeeze test is highly reliable: squeezing the sides of the heel between the examiner’s thumb and index finger reproduces the child’s typical pain. Children often walk on their toes to avoid heel contact. Sever’s disease is self-limiting—it resolves completely when the growth plate closes, typically by age 15–16—but symptoms can significantly limit activity for 2–18 months without treatment.
Treatment for Sever’s Disease
| Treatment | Evidence | Practical Notes |
|---|---|---|
| Heel cups / heel lifts (12–15mm) | Strong; first-line treatment | Placed in both shoes; reduces Achilles traction angle; immediate symptom relief; use in all shoes including cleats |
| Calf stretching (Achilles stretching) | Strong; essential for recovery | 3 × 30 seconds, 3× daily; both straight-knee and bent-knee (gastrocnemius + soleus); most important long-term intervention |
| Activity modification | Strong; necessary for significant pain | Reduce high-impact activities by 50–75% during flare; complete cessation rarely needed; cross-training (swimming, cycling) maintained |
| Ice after activity | Moderate | 15 minutes over heel after sport; reduces post-activity inflammation |
| Custom orthotics | Moderate; for flatfoot or recurrent cases | Addresses underlying biomechanical drivers; most valuable for flatfooted children with recurrent Sever’s |
| NSAIDs (ibuprofen) | Moderate; adjunct for acute flares | Weight-based dosing; short-course (5–7 days); not a long-term solution |
| Short-leg walking cast / boot | Reserved for severe cases | 2–4 weeks when severe pain limits all activity; followed by progressive return with heel cups and stretching |
Will My Child Miss the Whole Season?
Most children with Sever’s disease do not need to miss their entire sports season. With heel cups, consistent Achilles stretching, and activity modification during flares, most young athletes can continue participating at a modified level. Pain that is rated 4/10 or less and does not alter gait is generally acceptable during activity. Pain rated 6/10 or higher, or limp during activity, requires temporary rest. Return-to-full-sport typically takes 2–8 weeks of compliant treatment for first episodes; recurrence during subsequent growth spurts is common and managed the same way.
- High Arch Support: PowerStep supination insoles deliver firm, flexible high arch support plus a deep heel cradle for comfort, stability & motion control, helping align feet, reduce pain, and protect against ball & heel pressure.
- All Day Comfort & Support: PowerStep Pinnacle High shoe inserts for women and men use premium dual layer cushioning to deliver heel to toe comfort and responsive bounce back with every step, without going flat.
- Relieves & Helps Prevent Pain: PowerStep Pinnacle High insoles for supination can help alleviate common foot conditions often linked to supination, including plantar fasciitis, Achilles tendonitis, fat pad atrophy, and Morton’s neuroma.
- No Trimming: PowerStep insoles move easily from shoe to shoe. Inserts are sized by shoe size for footwear with removable factory insoles. Designed for walking, running, work & casual dress shoes; pairs well with best walking shoes for women and men.
- Made in the USA: We stand behind our PowerStep Insoles for women and men. Proudly made in the USA & backed by a 30-day money-back guarantee. HSA & FSA Eligible
Pediatric Heel Pain Evaluation at Balance Foot & Ankle
We see children with heel pain at our Howell (4330 E Grand River Ave) and Bloomfield Hills (43494 Woodward Ave #208) offices. We offer clinical examination with squeeze testing, in-office X-ray when needed, custom orthotic casting for flatfooted children, and sport-specific return-to-play guidance. Call (810) 206-1402 to schedule a pediatric foot evaluation.
Ready to Get Relief?
Same-day appointments available in Howell & Bloomfield Hills, MI
4.9★ | 1,123 Reviews | 3,000+ Surgeries
Or call: (810) 206-1402
For a complete clinical overview: Heel Pain Causes & Treatment Guide — every cause of foot and heel pain diagnosed
What causes sharp heel pain in the morning?
Plantar fasciitis — the fascia tightens overnight and micro-tears with first steps. Heel spurs and Achilles tendonitis cause similar pain.
When should I see a podiatrist for heel pain?
If heel pain persists more than 2 weeks, limits walking, or follows an injury with bruising or swelling.
Doctor Answer
What causes heel pain in children and when is treatment needed?
Heel pain in children between ages 8-14 is Sever’s disease (calcaneal apophysitis) until proven otherwise — the Achilles tendon pulls on the still-cartilaginous growth plate during growth spurts and high activity. It is bilateral in 60% of cases and worsens with running and jumping sports. Treatment includes calf stretching, heel cushions, temporary reduction of high-impact activity, and in persistent cases a walking boot. Sever’s resolves permanently when the growth plate closes around age 14-15. Younger children with heel pain warrant evaluation for other causes including tarsal coalition.
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 made him one of the most-followed foot & ankle educators on YouTube.