Heel Pain

Heel Pain in Children (Sever’s Disease)

Why Does My Child Have Heel Pain?

Heel pain in children is very common and usually occurs during growth.
It is caused by inflammation at the growing part of the heel bone, where the Achilles tendon attaches.

The pain typically:

• Increases with running and sports
• Settles with rest
• Occurs in active, growing children

The main reason is tight calf and hamstring muscles pulling on the growth area of the heel.

Other contributing factors include:

• Rapid growth spurts
• High activity levels
• Low vitamin D levels

Do children grow out of it?

Yes — most children improve naturally as growth completes.

However:

• Reducing activity helps control symptoms
• If muscle tightness is not treated, the pain may later shift to the heel pad (plantar fasciitis)

So treating the tight muscles is important to prevent ongoing problems.

Treatment Options

Treatment is almost always non-surgical.

1. Physiotherapy

Stretching exercises for:

• Calf muscles
• Hamstring muscles

This is the most important treatment.

2. Vitamin D Supplementation

Correcting low vitamin D helps bone health and reduces recurrence.

3. Serial Casting (For Persistent Symptoms)

If pain continues despite exercises:

• Walking plaster casts are used to gradually stretch the muscles
• Usually required for about 4 weeks
• Children can still attend school and walk in the casts

Does Surgery Help?

Surgery is rarely required.

It is only considered when there is fixed muscle tightness, commonly seen in children with neurological conditions such as:

• Cerebral palsy
• Autism
• ADHD
• Developmental delay

The type of surgery depends on the tightness pattern (Silfverskiöld test):

• Selective gastrocnemius lengthening, or
• Achilles tendon lengthening