There are various reasons for heel pain in adults, but in children the commonest by far is a condition known as Sever’s disease. As this is an injury to the growing area in the back of the heel bone, it would not occur in adults. The most typical age of onset is around the early teenage years or a bit before. When we are born the heel bone expands from two regions, one being the main area of the heel bone and the other being the growth area at the back of the heel bone. These two zones of bone are split up by a zone of cartilage material. Severs disease happens when there is too much stress on that region of cartilage.
The key causes are simply just too much physical activity done to increasing amounts so that the bone does not get enough time to get used to the stress that are put on it. Usually the child is participating in lots of sports activity, generally on hard surfaces. Limited calf muscles may also be commonly present. The chief sign is pain around the edges of the heel bone at the back of the heel and pain on activity. Increasing the level of sporting activity also should make it more painful.
The main approach to the management is a lowering of activity so that strain on the growing area of bone is minimized. Commonly a soft heel lift is needed to safeguard the area and reduce the pull from the Achilles tendon. Ice after exercise to help with pain can be useful. If this is not working well, an additional reduction in the amount of sports activity is necessary and in the most recalcitrant cases, a walking splint or cast can be used to significantly minimize physical activity levels. If all this fails, which it in some cases does, then it is just a matter of taking care of it until the two areas of growing bone combine to form one and it will not be a problem.