Heel Pain in Children and Adolescents

Heel pain is a very common symptom in adults. Occasionally, however, a child or adolescent may experience heel pain.

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 muscle attaches to 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.

Other possible causes of heel pain in children and adolescents include:

• Calcaneal apophysitis: The calcaneus, also known as the heel bone, has an area where growth of the bone 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 8 and 14. The condition can be aggravated by increased activity, especially if there has been strain on the Achilles tendon from such activities as jumping or sprinting. Examples include heel pain from soccer and basketball.

X-ray image of a child's heel bone growth plate.

• 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 and painful to the touch.


• Bursitis: Bursitis can also cause pain 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.

Image of a bursa.

• 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.

Image of the Achilles tendon and plantar fascia.

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. If structural or functional problems with a child's feet are contributing to the heel pain, Dr. Raymond DiPretoro may prescribe or recommend shoe orthotics. An ankle brace or support may also be prescribed.

Other Less Common Causes of Heel Pain

Seek a medical evaluation if treatment for the common causes of heel pain does not result in improvement.

• Rheumatic - Inflammatory conditions such as juvenile rheumatoid arthritis and juvenile spondylarthropathies can cause heel pain. The juvenile spondylarthropathiesinclude 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 other imaging study