Adolescent Heel Pain: Get the Answers You Need to Play the Sports You Love

Adolescence and the early teen years are typically when sports-loving kids start to really develop their physical skills, learn the value of teamwork and strategy, and gain even more opportunities to play different sports or on different teams throughout the year.

The last thing any child should have to worry about at this exciting time in their life is heel pain keeping them from playing their favorite sports.

Unfortunately, adolescent heel pain is a much more common problem than you might think. And it’s not just because kids are specializing or overtraining at earlier ages. During the adolescent years, heels may be uniquely vulnerable to injury in ways that adult feet are not.

The most common cause of heel pain in kids—Sever’s disease, also known as calcaneal apophysitis—is a great example of this.

What is Sever’s Disease? The Short Answer

First things first: the name is a misnomer. Sever’s isn’t a disease at all. Hopefully that’s some relief for you.

The short answer is that Sever’s disease is an injury to a soft section of the heel bone known as a growth plate. This type of injury can produce mild-to-moderate pain and tenderness underneath the heel, along with mild swelling.

A child with Sever’s disease may find it difficult or uncomfortable to play sports, be active, or spend much time walking or standing. In more serious cases, significant pain and even limping may be observed.

What is Sever’s Disease? The Long Answer

So in order to understand Sever’s disease, you need to understand something about kids’ feet and how they grow.

At this time in life, bones are still relatively soft, and growing rapidly. To enable this growth, the ends of many bones (including the heel bone) are “capped” with a softer section of cartilage tissue known as an epiphyseal plate, better known as a growth plate.

By the time the skeleton matures—around the mid-to-late teens for most of us, though as late as the early 20s for some—those growth plates get covered up by hard bone. But during childhood, they are unprotected and much more susceptible to injury.

Growth plates in general are more prone to irritation and cracking than mature bones, and for obvious reasons the heel growth plates are the most endangered due to the high amount of force and weight that even a child’s feet must bear.

And during adolescence, the risk of damage to the growth plate of the heel is especially high. Not only are kids likely to be engaging in more vigorous physical activity, but they are also likely going through some growth spurts.

As a result of these growth spurts, the development of different systems (bones, muscles, tendons, etc.) may be slightly “out of sync” with one another. The heel, in fact, is typically one of the first body parts to reach full adult size.

If growth of the heel bone outpaces the soft tissues that connect to it to a large enough degree, it could result in tight muscles and tendons in the back of the leg—which are more likely to tug and pull on the heel bone and irritate the growth plate.

What Are the Causes and Risk Factors?

So now you understand the biology and biomechanics behind the injury—but that doesn’t necessarily explain how your child ended up with Sever’s disease. After all, lots of kids play lots of sports without any problems.

“Why my child?” you may ask yourself. It’s a reasonable question.

Unfortunately, we can’t always say with 100% certainty why one child is affected and another is not. However, there are a number of risk factors that correlate with greater risk—some of which we’ve already touched on above:

• Being active. Sever’s disease is an overuse injury. Kids that play a ton of sports without much rest are more likely to develop it.
• Certain sports. Not all sports are created equal when it comes to Sever’s. Those played on hard surfaces and that involve running and jumping come with the highest risk. Basketball, gymnastics, track, and certain types of dance, for example.
• Active growth spurt. As detailed above, being in the middle of a growth spurt increases the risk that tendons and muscles will become tight and pull uncomfortably on the heel.
• Poor shoes. Athletic shoes and cleats that are too small, too large or too flat (i.e.: do not provide adequate arch support) can magnify the force loads on the heel bone.
• Obesity. While Sever’s disease is more commonly associated with highly active kids, those who are substantially overweight are also at elevated risk. A heavier child will naturally put more weight and force on their feet during any given activity than a lighter one.

What Should You Do if Your Adolescent is Suffering from Heel Pain?

If this is the first time your child has shown these kinds of symptoms, the advice is fairly straightforward—simply get some rest.

Your child will need to temporary stop playing the sports or performing the activities that were causing pain, and wait until symptoms improve. Using ice packs occasionally may help with the swelling.

Once your child is feeling better, make sure your little athlete starts slowly, and gradually increases playing time to pre-injury levels.

If, however, the symptoms are severe, don’t go away after a week or two, or keep coming back, it’s best to make an appointment with the Colorado Center for Podiatric Sports Medicine.

What We Can Do For Your Little One

We’ll start with the good news.

You should be pleased to learn that the vast majority of Sever’s disease cases are both temporary and treatable through conservative means only, and shouldn’t cause any long-term problems with your child’s feet.

However, it’s best not to wait too long to seek treatment if Sever’s disease pain is not subsiding on its own. The most serious cases may require more than a month of rest time followed by a strength and conditioning program, so it’s best to not wait until the situation gets that bad!

Often, a good pair of athletic shoes or cleats and orthotics from our office are the best solution to stubborn adolescent heel pain. These will provide much more optimal cushioning and support for the feet, alleviating the bulk of the excess pressure on the heels.

If necessary, we may recommend further conservative options such as physical therapy exercises, over-the-counter medications, or advanced conservative treatment options like laser therapy. Surgery is almost never necessary for Sever’s disease.

Finally, we want you to know that your child is in good hands with Dr. James Yakel. As team podiatrist of the Colorado Rapids, he works with professional athletes at the top of their games—but he’s just as passionate about helping youth athletes of all skill levels getting back to playing the games they love.

To schedule an appointment with our team in Colorado Springs, give us a call at (720) 600-3380 today.