Heel Pain in Children and Adolescents

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Heel pain is a very common symptom in adults, but children and adolescents may also complain of it. There are several conditions that can cause heel pain in young people. Explore when it may be normal growing pains and when heel pain may indicate a more serious condition.

Growing Pains Affecting the Heel
When a child complains of heel pain, it is often thought to be growing pains, a normal phenomenon during childhood and adolescent growth spurts. Growing pains are a simple way of describing mild and short-lived pain, usually in the legs where a muscle attaches to a bone. During growth spurts, a bone may grow faster than muscle, resulting in muscle or tendon strain that causes mild pain or discomfort. It tends to occur late in the day or at night, after a busy day of activity.

Calcaneal Apophysitis
The calcaneus, also known as the heel bone, has an area where bone growth occurs (known as an apophysis). It is located at the back of the heel bone, near where the Achilles tendon attaches. This growth plate is subject to pulling and tension from the tendon, which can lead to a painful heel.


Calcaneal apophysitis, which is also called Sever's disease, usually occurs between the ages of 7 and 14. The condition can be aggravated by increased activity, especially if there has been strain placed on the Achilles tendon from such activities as jumping or sprinting. Examples include heel pain from soccer and basketball.

Achilles Tendonitis
Like calcaneal apophysitis, Achilles tendonitis is brought on by strain on the Achilles tendon, either by increased activity or tightness of the calf muscles, which kids commonly experience during growth spurts. The tendon is painful with activity (especially running and jumping) and in the morning there is often pain and stiffness.

Bursitis
Bursitis can also cause pain and swelling near where the Achilles tendon attaches to the heel bone. Bursitis is inflammation of a bursa, which is a pocket of fluid adjacent to the tendon. Bursitis is caused by tendon strain or irritation of the tendon from rubbing against a tight shoe.

Plantar Fasciitis
Pain on the bottom of the heel may be caused by plantar fasciitis. The condition is caused by inflammation on the underside of the heel bone, where a band of connective tissue called the plantar fascia attaches. Plantar fasciitis is often caused or aggravated by problems with foot function, such as flat feet or high-arched feet. Children will usually say that their heel pain is worse in the morning and with activity.

Less Common Causes
Seek a medical evaluation if treatment for the common causes of heel pain does not result in improvement. Here are less common, but more serious conditions that can cause heel pain.

Inflammatory conditions such as juvenile rheumatoid arthritis and juvenile spondyloarthropathies can cause heel pain. The juvenile spondyloarthropathies include reactive arthritis, psoriatic arthritis, and ankylosing spondylitis.
Congenital bone fusions, also known as tarsal coalitions
Bone fractures
Ulcerative colitis and Crohn's disease
Tumors or bone cysts—rare causes of pain that are diagnosed by X-ray or another imaging study

Treatment
What all of these conditions have in common is that they are caused by physical stress on the feet. Once a diagnosis has been made, the treatment plan will likely involve rest and daily stretching of the ankle and foot. Sometimes physical therapy is recommended to improve flexibility and strength.

If structural or functional problems with a child's feet are contributing to the heel pain, a podiatrist may prescribe or recommend shoe orthotics or some other change in footwear. An ankle brace or support may also be prescribed.