Pain in the heel of children is not common, but when it does happen, the most common reason is a condition known as Severs disease. It is not really a “disease”, but it is the name that has unfortunately stuck. It is correctly called calcaneal apophysitis. It is a problem with the growing area at the back of the heel bone. As it is a problem, of the growing bone, the condition is self-limiting and will no longer be an issue when the growth of that bone has finished. It is more common around the ages of 10-12 years.
The classic symptom of Severs disease are pain on activity and pain on squeezing the sides of the back part of the heel. Initially the pain is minor and does not affect activity much, but later it becomes more severe and affects sports participation and may even cause limping. The exact cause of it is not known, but it is clearly and overuse type problem as it is more common in those who play more sport and more common in those who have a higher body weight. Those with tighter calf muscles may also be at a greater risk for the development of this problem.
Typically, the treatment of Severs disease is modified rest. The child is encouraged to remain active, but judge reduce activity levels to a level that can be tolerated and not too painful. A soft heel raise in the shoe may be useful to protect it. Ice after activity may also be useful to help the symptoms. If the calf muscles are tight, then a stretching program should be started. Sometimes foot orthotics can be helpful if the arch of the foot is flat. On rare occasions a brace can be used, and all activities stopped until it heals. By the mid-teens the grow plate that this occurs at merges with the rest of the heel bone, so this ceases to be a problem at those ages.