Heel pain & children

Calcaneal apophysitis (also known as Sever’s disease) presents as pain at the back of the heel and commonly occurs in children between the ages of 8 and 14. During this time period, the growth plate at the back of heel bone is most active. An apophysis is a growth plate that is located at the attachment of a tendon and as a result can become inflamed as the Achilles tendon is placed under repetitive load.

Typically, the symptoms are mild and self-resolve in the short to medium term with nil to minimal need for treatment. However, this is not always the case and therefore a consult with your local health professional is valuable to rule out other diagnoses and to discuss whether treatment is required.

Simple and low-cost interventions tend to be the first line treatments and these include heel wedges, modification of activities, guidance on footwear choice and education.

Heel wedges can be placed within a shoe to elevate the heel bone with the purpose of reducing the load at the insertion of the Achilles tendon. They can be easily placed under the insole of a shoe and a health professional can provide guidance on the appropriate height and composition of the wedge.

Activity modification often involves minor changes to the timing and frequency of activities. For example, jumping or running activities can be spaced further apart to allow the apophysis greater recovery between periods of high loading. Sometimes a small change can make a big difference.

An assessment of footwear can help to identify whether there is an appropriate pitch (the height difference between the back and front of a shoe), any areas of heel impingement at the cup of the shoe or sufficient support within the shoe structure.

Education is possibly the most valuable tool in treating apophysitis. Understanding of the condition and the likely timeline helps to shape an effective management plan and expectations.

If first line management options are not sufficient to resolve the symptoms, imaging and further treatment options may need to be considered and your health professional can guide you through this process.

If you are concerned about your child’s foot pain, feel free to get in touch to make an appointment.