It usually starts the same way. Your child limps off the pitch, or complains going up the stairs after training, or asks to skip a session. By the next morning they seem fine, so nobody thinks much of it.
Then it happens again the following week. And the week after.
Heel pain in an active child aged roughly eight to fifteen is most commonly a condition called Sever’s disease, or calcaneal apophysitis. The name sounds alarming and the condition isn’t. But it does need managing properly, because the alternative is a child who quietly stops enjoying their sport.
Here’s what’s actually going on and what to do about it.
What’s Happening in Their Heel
Children’s bones don’t grow uniformly. At the back of the heel there’s a growth plate — an area of developing bone that hasn’t yet fused with the main heel bone. The Achilles tendon attaches right at that area.
Two things then combine.
Repetitive impact. Running and jumping transmit force through the heel thousands of times a session. In a mature skeleton that load goes through solid bone. In a growing one, it goes through an area that’s still developing.
Growth outpacing the muscles. Bone lengthens faster than muscle and tendon adapt during a growth spurt. That leaves the calf relatively tight, which increases the pull of the Achilles on the growth plate at exactly the moment it’s least able to tolerate it.
That’s the whole mechanism: traction on a growth plate that’s still ossifying, from a calf that’s temporarily too short for the leg it’s attached to.
Who Gets It
Age eight to fifteen, corresponding with growth spurts — typically around 8 to 13 in girls and 10 to 15 in boys. It’s been observed in children as young as six, and it’s rare in older teenagers, because once the growth plate has fused the mechanism no longer applies.
More common in boys. One review of 28 studies covering over 1,300 cases found roughly 71% were boys, with a mean age of around 10.7 years.
Both heels, often. In that same review it was bilateral in around 43% of cases and one-sided in about 32%.
Sports involving running and jumping. Soccer, athletics, cross-country, gymnastics, tennis and ballet all feature prominently — which in an Irish context means GAA, football, athletics and dance are all common contexts.
Two risk factors stand out: high levels of physical activity, and higher body weight.
And one that surprises people: it can also develop in less active adolescents who wear flat shoes, because flat footwear increases the demand on the calf and Achilles.
How You’d Recognise It
Pain at the back or sides of the heel, rather than underneath.
Worse during and after activity, better with rest. This is a key feature — pain that eases when they stop is characteristic.
Limping, particularly at the end of a session or the following day.
Walking on tiptoes, sometimes unconsciously, because it takes tension off the heel.
Tenderness when you squeeze the heel from both sides. This squeeze test is one of the things a clinician checks, and it commonly reproduces their pain.
Stiffness after sitting, and reluctance to do things they normally want to do.
Diagnosis is clinical. Imaging is generally used to rule out other problems rather than to confirm this one.
What Actually Helps
The encouraging headline: this is managed conservatively, and surgery is never required.
Activity modification rather than complete rest. This is the cornerstone, and the distinction matters. The goal is reducing volume and intensity to a level their heel tolerates — not stopping sport entirely. Guided by pain rather than by a fixed timetable.
Heel cups or heel lifts. These reduce the traction on the growth plate and often provide noticeable relief. The evidence suggests the benefit is largely short-term, which makes them useful as symptom control while the underlying factors are addressed.
Calf stretching and dorsiflexion strengthening. This addresses the actual driver — a calf that’s tight relative to a rapidly lengthening leg. It’s the part most likely to be skipped once the pain eases, and the part most likely to prevent recurrence.
Custom foot orthoses. Worth highlighting, because a review of the conservative treatment evidence found custom-made orthoses improved biomechanical alignment and outperformed off-the-shelf heel lifts. If the mechanics are contributing, a prescribed device addresses more than a cushion does.
Ice and simple pain relief for acute symptom management.
Physical therapy input, which in the reviewed evidence facilitated return to sport within around two months.
Immobilisation, in more severe cases, though this is uncommon.
What the evidence supports less strongly: kinesio taping improved function but produced pain relief comparable to placebo, and shockwave therapy showed some promise but lacked robust evidence in this population.
Footwear Matters More Than Parents Expect
Two specific things worth checking.
Studded boots. Football and GAA boots typically have minimal heel cushioning and a low heel, which increases demand on the Achilles and heel. Boots are frequently the setting in which symptoms appear.
Flat shoes generally. Completely flat trainers, canvas shoes and some school shoes increase calf and Achilles load. A shoe with a modest heel-to-toe drop and genuine cushioning is easier on a growing heel.
Also worth checking: whether the boots or trainers still fit. Feet in this age group change size quickly.
What to Tell Your Child
This part matters, because how a child understands the problem determines whether they report it or hide it.
It’s not damage, and it’s not permanent. The pain relates to a growth plate that will fuse, and the condition resolves once that happens.
Telling you early costs them less time. Children conceal pain because they fear losing their place on the team. The honest framing is the reverse — managed early, most children stay playing in a modified form. Ignored for a season, it takes far longer.
They’re not being soft. Sever’s is genuinely painful and it’s a recognised condition, not a complaint to push through.
What Not to Do
Don’t insist they play through it. In rare cases, untreated calcaneal apophysitis has been reported to result in an avulsion fracture at the growth plate.
Don’t stop all activity indefinitely either. Complete rest resolves symptoms and does nothing about the calf tightness or mechanics, so it usually returns as soon as they go back.
Don’t assume it’s growing pains. That phrase covers a lot of ground and delays assessment. Sever’s is a specific condition with specific management.
When to Get It Checked
Any heel pain in a child persisting more than a couple of weeks warrants assessment — partly to confirm what it is, partly because other causes exist.
Seek prompt medical assessment for heel pain following a specific injury or fall; inability to bear weight; swelling, redness or warmth; heel pain with fever or a generally unwell child; pain that’s present at rest and at night rather than activity-related; pain that’s worsening despite reduced activity; or heel pain alongside pain in other joints, prolonged morning stiffness, rashes or bowel symptoms — which can indicate an inflammatory condition needing different care.
The Reassurance, and the Caveat
Sever’s disease is self-limiting. It resolves once the growth plate fuses, and it doesn’t cause long-term damage in the vast majority of cases.
The caveat is that “it’ll resolve eventually” can mean two or three years of a child limping off pitches and gradually withdrawing from sport they love. Properly managed, most children stay playing throughout — which is a considerably better outcome than waiting it out.
Get It Assessed Properly
An examination takes one appointment and usually produces a clear plan the same day.
Foot Focus offers a free call back today at no cost and no obligation. Bring your child and their boots. You’ll get a proper assessment of their heel, calf, and foot mechanics at our Finglas or Mount Merrion clinic, plus a practical plan for keeping them in their sport while the heel settles.
If their presentation suggests something other than Sever’s, we’ll tell you plainly and help you get to the right place.