Heel Pain in Children: Understanding Growth-Related Heel Pain

Heel pain is a common reason children and adolescents present with foot pain, particularly if they are active or experiencing a growth spurt. In most cases, heel pain in children is related to growth and activity load rather than serious injury.

Common causes

One of the most common causes of heel pain in children is irritation around the growth plate at the back of the heel. This typically affects children between 8 and 14 years of age and is more likely to occur during periods of rapid growth or increased sporting activity.

Less commonly, heel pain may relate to trauma, nerve irritation, or inflammatory or systemic conditions. These are considered when symptoms do not follow a typical pattern or do not improve with conservative care.

Typical features

Children with growth-related heel pain may experience:

• pain during or after running and jumping

• limping, particularly after sport or at the end of the day

• tenderness at the back or underside of the heel

• relief with rest or reduced activity

Symptoms are often activity-related and may fluctuate depending on training load.

What does current evidence suggest?

Research and clinical guidance indicate that:

• growth-related heel pain is usually load-related, not caused by permanent structural damage

• temporary reduction in load, combined with strengthening and footwear review, is central to management

• simple supports such as heel cushions or orthoses may improve comfort for some children, but are not always required

• most children recover well over time with conservative management

Imaging is not routinely required unless symptoms are atypical or not improving as expected.

How we assess heel pain

Assessment typically includes:

• discussion of symptoms and recent changes in activity or sport

• review of training load and footwear

• strength and flexibility assessment, particularly of the calf muscles

• observation of walking and running patterns

The focus is on identifying contributing factors and guiding appropriate load management.

Management options

Depending on the child’s presentation, management may include:

• short-term activity modification to reduce pain

• strengthening exercises, particularly for the calf and foot muscles

• advice on supportive footwear

• heel cushions or orthoses where appropriate

• education around pacing, recovery, and gradual return to activity

Most children improve with time and simple strategies, rather than aggressive treatment.

When to seek help

It is recommended to seek assessment if heel pain:

• is persistent or worsening

• causes ongoing limping

• is present at night or at rest

• significantly limits participation in sport or daily activities

These features may indicate the need for further review or referral.

This information is general in nature and is not a substitute for individual assessment, diagnosis, or medical advice from a qualified health professional.

Sources 
The Royal Children’s Hospital Melbourne – Kids Health Info: Heel pain / calcaneal apophysitis
NHS UK – Heel pain in children
Micheli LJ et al. Overuse injuries in the growing athlete (summary evidence)
Australian Podiatry Association – Consumer foot health resources