The usual suspect
Sever's disease, or calcaneal apophysitis, is irritation of the growth plate at the back of the heel bone where the Achilles tendon attaches. It is the single most common cause of heel pain in active children and shows a very recognisable pattern: pain at the back of the heel, tender when the heel is squeezed from both sides, worse during and after running and jumping, and often worse on hard surfaces or in football boots and studs.
It is self-limiting, resolving as the growth plate fuses in the mid teens, but it can be miserable for a season if the training week never changes.
What else can cause heel pain in a child
| Where and how it presents | What it may be |
|---|---|
| Underneath the heel and arch, worst on the first steps in the morning | Plantar fasciitis, less common in children than adults |
| Swollen, thickened area just above the heel bone, sore in stiff shoes | Achilles or retrocalcaneal irritation |
| Pain, morning stiffness lasting over 30 minutes, more than one joint involved | Inflammatory cause such as juvenile arthritis, needs a GP |
| Sudden pain after a fall or landing, unable to weight bear | Possible fracture, needs urgent assessment |
| Constant pain unrelated to activity, night pain in one fixed spot | Needs medical assessment, do not manage as load |
Other causes worth keeping in mind.
What helps most
None of this fixes the growth plate, it matures on its own timeline. What it does is close the gap between what the heel can tolerate and what the week is asking of it, so a young athlete keeps playing and keeps developing.
- Reducing, not removing, the running and jumping volume for a few weeks, then rebuilding it deliberately.
- Calf strength: heel raises progressed from both legs to one leg, then to loaded and faster variations.
- Calf and hamstring flexibility, which is commonly restricted through a growth spurt.
- Cushioned trainers rather than flat or worn shoes for training on hard surfaces, and limiting time in studs.
- A heel raise or gel heel cup in the shoe, which many children find takes the edge off during the irritable phase.
A simple weekly check
The morning-after rule
Ask one question after each session: is the heel worse, the same, or better than yesterday morning? Worse for two sessions in a row means the dose is too high. The same or better means you can hold, and after a fortnight of better, add a little back.
When to seek help
See a physiotherapist or GP if your child is limping for more than a week or two, if the pain is not following the pattern above, if both heels are painful along with morning stiffness elsewhere, or if progress stalls despite sensible load changes. Persistent heel pain in a young athlete is common, and it is also very treatable with the right structure.