Heel pain is a common problem in both adults and children, but they are generally commonly caused by two totally different unrelated entities. In adults, the most common cause of heel pain is a condition known as plantar fasciitis and the most common condition in children is a condition known as calcaneal apophysitis or Sever’s disease. One is an overuse problem of the plantar fascia and the other is an inflammation in the growing plate at the back of the heel bone.

The plantar fascia is a strong ligament that supports the arch of the foot, so anything such as higher activity levels, tight calf muscles or being overweight which puts more pressure on the arch is going to increase the risk for plantar fasciitis in adults. The characteristic symptom of this is pain under the heel that is significantly worse in those first few steps after rest, especially getting out of bed in the morning. This pain does tend to improve after those first few steps but does tend to be progressive. The best way to deal with plantar fasciitis is to lose weight, do lots of stretching for the calf muscles and use foot orthotics to reduce the force that gets applied to the plantar fascia. Ice can be used on it and anti-inflammatory drugs could also be used if the pain is limiting daily activities. There are other modalities such as injection therapy and shock wave therapy that can also be used to help facilitate healing. In rare cases surgery might in needed.

At the back of the heel bone in children is a growth plate where the growth of the bone occurs at. These growing areas of bone are prone to being damaged if the child is overweight or very active. Severs disease at the back of the heel bone is very common in children in the late pre-teen years. The growth plate merges with the rest of the heel bone in about the mid-teenage years, so Sever’s disease is always self-limiting and will go away on its own when this occurs. Just because it is self-limiting does not mean that it should not be treated as it can be quite painful and distressing for the child who has it. The pain is typically at the back of the heel bone, especially if you squeeze it from the sides and is worse with increased levels of activity. Occasionally, the pain from the condition can cause the child to limp. The first approach to treatment is education as to the exact nature of the problem and to manage how active the child is. Managing this is challenging as they want to be active both in sport and at school, but activities need to be restricted to what they can tolerate. Activity levels can be increased as it improves. Ice can be used after sport if it is painful. Cushioned heel pads are also particularly helpful at reducing the forces on the heel bone. Foot orthotics can also be helpful in many cases.