Heel Pain in the Young Athlete

Heel pain is one of the most common symptoms I see in young athletes.  Often, the pain is so bad that it keeps kids from being able to practice and compete.  Occasionally, the heels become so severely painful that it is difficult for the athlete to even walk without limping.

So what is the cause of this scourge of the active young athlete?  Chances are someone on your team or in your league, or even an older sibling has suffered from it—Sever’s Disease.

Sever’s Disease is an inflammation of a small growth plate at the back of the heel.  It’s not a growth plate that is active to make a child taller.  Rather, this growth plate, called the calcaneal apophysis, is where the Achilles tendon attaches to the heel.  As the bones of the leg grow longer, the muscles and tendons don’t lengthen at the same speed, causing them to get tighter.  The job of the calcaneal apophysis is to allow for some wiggle room so the tendon doesn’t just pull off the bone as the bone grows.  Unfortunately, when an athlete is growing quickly, the tension of the Achilles on the apophysis can become too much, causing it to inflame.

In addition to the inflammation, athletes are constantly banging on the bottom of the heel in their cleats and shoes.  Cleats in any sport, from soccer to baseball, are usually less cushioned and cause more stress on the heel—and the growth plate.  This causes more pain.

Athletes with Sever’s Disease are usually between ages 8 and 13 and usually report pain with running, jumping, and landing.  They describe the pain as starting slowly, without any obvious injury, and feeling like the heel is “bruised.”

Once the diagnosis is made, the treatment is pretty simple. The first and most important treatment is rest.  But the athlete doesn’t have to just stick to the couch.  He or she can participate in activities that do not cause pain, like cycling or swimming, to keep their fitness up while they rest the foot.  Parents can provide ice and anti-inflammatory medicines.  I recommend a silicone heel cup to provide some cushion and pain relief.  The athlete can perform one of the most important treatments him or herself—and that’s stretch, stretch, stretch, stretch, stretch that Achilles.  The more flexible it is, the less it will pull on the growth plate.

Other problems can cause heel pain, as well.  Diagnoses like stress fractures and bone cysts can also be to blame, and the differences are subtle.  If pain persists despite rest and stretching for more than a week or so, the athlete should consult his or her physician.