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:

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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.