Heel Pain in Youth Soccer Players

If you coach or have coached kids at the U10-U14 level, especially at the competitive level, you are probably familiar with heel pain. But you may not know what causes it and why it can sometimes seem like players are always having heel trouble.

Last year, a teammate of my daughter was having severe heel pain. First thought to be the result of an ankle sprain, it wasn’t getting better like a sprain normally would. It was getting worse. I happened to notice once during practice, where she appeared fine, that she went to kick a ball and kicked the ground. Her face contorted in pain and she was done. I hadn’t seen her ankle turn or twist in an awkward direction. Yet if you squeezed the side of her heel, she cried out. She eventually sat out for 3 months to let things heal.

That was my first exposure to Sever’s Disease. Now, three of the players on my U12 girls team have it, so I did some research and figured I’d share it.

The good news is the condition is manageable and is unlikely to cause any permanent damage. But it still hurts. Thankfully the remedies are pretty straightforward.

I’m not a doctor, etc., etc. so you should obviously consult a specialist if you fear your child has any type of foot injury. Information here is provided for your reading enjoyment only.

The teammate of my daughter went to see a podiatrist and he explained that the pain was due to inflammation of the heel. Specifically, in children there is a growth plate on the back of the heel:

sever1.gif

An xray showing the heel's growth plate

In kids that play sports, until the plate fuses to the main part of the heel (as teenagers), shearing forces on the plate from the Achilles tendon and any trauma to the heel can cause pain and it can be intense. Here is a description of the condition from AthleticAdvisor.com:

This condition is most common in children between 10 and 14 years of age. It is very similar to Osgood-Schlatters Disease seen in the knee.

Pain is felt in the back of the heel. Some shoes may make the pain worsen due to pressure on the sore heel. In some cases there may be pain that wraps around the heel, ending on the bottom of the foot near the beginning of the arch of the foot. This is due to the anatomy of the area. The Achilles Tendon does not end at the calcaneus but continues around and completes its insertion on the bottom of the bone where the long arch of the foot begins.

As with Osgood-Schlatters, Severs is caused by increased shearing forces on the growth plate. This causes mild swelling in the area and pain. As stated earlier, sports participation will worsen the symptoms, but they will often subside when activities are stopped.

Due to the rapid growth 10 to 14 year olds experience, muscle flexibility needs to be evaluated. Tight calf muscles (both the gastrocnemius and soleus) can exacerbate symptoms by adding to the shearing forces on the calcaneal epiphysis.

Another excellent overview, which talks about the specific stresses youth soccer can place on the heel, can be found at Meadowlark Physical Therapy (it’s a Word document). I’ve collected a variety of links with information about heel pain in children so you can get a feel for what various experts are saying about it:

So what are the experts saying? Soccer cleats are very hard on the feet, and the hard ground most kids play on doesn’t help. Competitive soccer can result in trauma and inflammation of the growth plate  until the bones fuse together. An easy way to tell if a player is having this problem is to squeeze the sides of their heel. It’ll hurt when you do. Some will tell you without the ‘squeeze test’ that the sides of their heel hurt in a place that seems odd if you’re used to dealing with ankle sprains.

Treatment and preventative options include:

  • RICE: Rest, Ice, Compression, Elevation. The RI part anyway. Heels should be iced 20 minutes a day, 1-3 times a day, even on days they don’t hurt, to help control the inflammation.
  • Reduce or stop activity if necessary due to the pain. Some recommend stopping sports activities completely, while others note that permanent damage is unlikely and to use the pain as your guide – if it’s managable with ice and other treatment/preventative measures, they likely will be fine if they ease back to let the inflammation subside and take other preventative measures.
  • Stretch the calf muscles daily to reduce the strain on the Achilles tendon and thus the growth plate.
  • Heel gel pads – though my players have found they tend to make it hurt worse in cleats. But reading these articles, it sounds like everyday walking at school is when the pads will help the most.
  • Wear cleats just for practices and matches. DON’T wear cleats to the car, walking across the parking lot/sidewalks.
  • Don’t go barefoot. I’m guessing wearing flip-flops or Rainbows isn’t a good idea either. Can’t wait to tell my team that! Wear quality sneakers/shoes with solid arch support and cushioned soles to reduce shock to the heel.
  • Consult a podiatrist about arch supports or heel pads or cups. IMPORTANT – if they wear heel pads or cups, calf stretches become extremely important to avoid a tightening/shortening of the Achilles tendon. Pads/cups should be worn daily, not just during soccer activities.
  • Consult a physician about the use of anti-inflammatory medications like Aleve or Advil to reduce the inflammation in the heel.

Obviously you should consult a specialist if the pain is intense or nagging. But some common sense steps like stretching and rest/ice may be able to prevent a small injury from becoming a big one that sidelines a player.In talking with various soccer parents and ex players – the heel pads and cups got rave reviews. The only problem with some flatter pads is they slip around during activity. Tulis makes a nice gel pad with a back lip to help keep it in place. Other companies with similar products include Muellers and Dr Scholl’s.

So the next time you have a player complain of heel pain and it’s not anywhere near the usual tendons and ligaments related to an ankle twist/sprain, it might be Sever’s disease.

ADDING: SAY has a page dedicated to Sever’s Disease and heel pain.

Leave a Reply

  1. Thanks! This was the first site I opened after search engine. It explained exactly what my 10 yr old daughter, playing on a U13 team, complained about. I’ll use the suggestions and hope that it will find her relief fast. Thanks a bunch!

  2. Thank you so much! This describes so well my daughter’s condition. She’s U10 and loves soccer but sick of heel pain and the doctors are baffled. Thank you for researching this. It certainly gives us a new starting point and direction in helping her. Great site, too!

  3. I’m so glad I found this article! My daughter plays U10 soccer and is also involved in dance. She has been complaining about heel pain since December. We thought it was just growing pains or sore muscles. After reading your article we went to the Dr and he confirmed it! It’s nice to know what the cause is so that we can take measures to minimize her pain. I’ll be passing this article along to my friends with kids in the Sever’s Disease age group:)

  4. Thank you so much!! This is right on the money. My daughter is 10 and plays U-12 and U-15 and we’ve wrapped and taped every way possible with no relief. This is excellent. Thank you!

  5. Great Article! My son plays Select Soccer U11 and competitive baseball. He’s been complaining since the early part of the year his heal has hurt. Took him to the doctor today and the first thing out of his mouth was Sever’s Disease. I found your article when researching the disease a little more. Thanks for the help!

  6. Hi. Thanks for the heel pain info. My son has this and I took your advice. I was amazed at how quickly it came good literally a day or two he had no more pain. Great resource, thanks for providing it. Toena

  7. Wonderful! My son was just ten earlier this year and this described perfectly his symptoms. I enjoyed also reading the preventative/treatment options with him as it was just about everything I advised him to do (very gratifying considering he seems to already know everything :). Thanks again!

  8. Thanks for the information. I was at a bar-b-cue last night and one of the dads on our football (soccer) team is a podiatrist and mentioned everything that you had in your article. Greta job!!! My son is due for new football boots and will gives the tulis heel pads a try.

    Cheers,
    Kevin

  9. Great information. I would add this from the Podiatrist we saw — only wear the heel lifts during play, practice, or intense running. The lifts are intended to prevent the stretching during times of high activity to avoid pain. Do not wear them to school or other activities as the Achilles needs to stretch naturally and the lifts prevent that. The idea is to build up strength.

  10. I did all of the above with regard to the heel lifts and reinforce Achilles stretch. The issue that I am encountering is trying to have a 10 year old do his stretches daily. Just like everything else with being a parent we need to keep vigilant, they won’t do it on their own.

  11. Excellent resource – I suffered from this problem as a child. I would counter that walking barefoot will help this problem as it allows the many muscles, tendons, bones of these complex structures(feet) to move and stretch normally and can help folks transition to less pain. Also stress stretching with your kids as they often refuse this important exercise component. My recent experience transitioning to a barefoot running style – I do half marathons now – has taught me how underused our foot structures have become with the advent of modern shoes. Modern shoes support feet to the extent that they become weak and inflexible. Our forefathers wore moccasins and flat sandals and hiked the world over remember.

  12. Our son was in excruciating pain, and we were told it was sever’s disease. We researched and researched and tried different things to help. We couldn’t find kids insoles in stores, so resorted to women’s, which didn’t fit his soccer shoe right. We finally tried the NxtMile youth insoles. It’s the only thing we’ve found that’s made specific for each sport shoe, since they are all cut differently. We tried the soccer ones, and he was able to play immediately. We saw that they now have them in baseball and basketball too (and soon football and lacrosse). It’s the only thing we’ve found that fits perfect in our son’s different sport shoes and kept him pain-free so he didn’t have to sit out anymore. We would highly recommend these to anyone who dealing with sever’s or oschgood-schlatters. You can find them at http://www.nxtmile.com.

  13. After reading this posting, the attached comments and all the various links, I am very optomistic now…Sure wasn’t before…I thought my 13 year old son had some form of rare problem…and all i could think of was “oh no, expensive orthopedic insoles, here we come!”

    This article describes EXACTLY what my son is going thru. He LOVES sports, he’s the jock of the family, and to not be able to play soccer this summer would be a form of child abuse to him! LOL!
    So, thank you for this article, and thank you to all the commentors, I have already ordered some insoles from http://www.nxtmile.com and as soon as they come in and that we’ve tested them, I’ll come back to post a follow up comment.

    Best,
    Eric

  14. Wondering if anyone else has tried the nxtmile insoles? We have now tried them in our son’s football and basketball shoes and he LOVES them! We bought an extra pair for him to wear in his everyday shoes (baseball fit best). Has anyone else had a chance to try them? Curious how they might be working for others.

  15. Thank you sharing the information. My 9 year old son has exactly the same issue. He plays football. While I showed the doctor and he advised rest, he just said it is a growing pain and did not go any further. Now that I understand it better I would be better able to help my boy.