Why Does My Child’s Heel Hurt After Running?
Heel pain after running is a common concern among active children, particularly those who participate in school athletics, cross-country running, football, basketball, and other sports involving running and jumping. While occasional soreness may seem harmless, persistent heel pain can affect a child’s ability to participate in sport, walk comfortably, and enjoy everyday activities.
One of the most common causes of heel pain in growing children is Sever’s disease, a condition associated with irritation of the heel’s growth plate. However, other conditions, including Achilles tendon irritation, plantar fascia pain, and bone stress injuries, can also cause discomfort.
Understanding why your child’s heel hurts after running can help you recognise potential causes, take appropriate action, and determine when professional assessment is necessary.
What Causes Heel Pain in Children After Running?
Children’s bodies undergo significant changes as they grow. Their bones, muscles, tendons, and growth plates must adapt to increasing physical demands, particularly during periods of rapid growth.
Running places repeated impact forces through the feet and heels. When training intensity increases too quickly, recovery is insufficient, or repetitive loading exceeds the body’s ability to adapt, heel pain may develop.
Several factors can contribute to heel pain in young runners, including sudden increases in training volume, frequent jumping activities, tight calf muscles, unsuitable footwear, and limited recovery between sporting sessions.
The location of the pain, the child’s age, the activities that trigger symptoms, and whether discomfort improves with rest can help a healthcare professional identify the likely cause.
1. Sever’s Disease: A Common Cause of Childhood Heel Pain
What Is Sever’s Disease?
Sever’s disease, medically known as calcaneal apophysitis, is one of the most common causes of heel pain in physically active children. It typically affects children between approximately eight and fourteen years old, although the exact age varies depending on growth and development.
The condition involves irritation of the growth area at the back of the heel bone, where the Achilles tendon attaches. During growth, this area is particularly sensitive to repeated pulling forces and impact from running and jumping.
Despite its name, Sever’s disease is not an infection. It is a growth-related condition that commonly improves as the heel matures.
What Are the Symptoms of Sever’s Disease?
Children with Sever’s disease may experience pain at the back or sides of the heel during or after running. Symptoms often become more noticeable after sports training, sprinting, jumping, or prolonged physical activity.
Other symptoms may include tenderness when the heel is squeezed, discomfort when standing on tiptoes, and occasional limping after exercise. Pain may improve with rest but return when the child resumes running.
Symptoms can affect one or both heels.
How Is Sever’s Disease Managed?
Management usually focuses on reducing activities that aggravate the pain while maintaining comfortable levels of movement. Temporary modification of running and jumping, suitable footwear, and calf flexibility exercises may help.
A healthcare professional or paediatric physiotherapist may recommend heel lifts, strengthening exercises, or a gradual return-to-running programme depending on the child’s symptoms and needs.
Children should not be encouraged to push through significant heel pain. Persistent symptoms warrant assessment to confirm the diagnosis and exclude other causes.
2. Achilles Tendon Irritation
Why Can the Achilles Tendon Cause Heel Pain?
The Achilles tendon connects the calf muscles to the heel bone and plays an important role in running, jumping, and pushing off the ground.
Repeated high-impact activity can irritate the tendon or the surrounding tissues, particularly when children suddenly increase their training load or have limited recovery time.
In growing children, pain near the Achilles tendon attachment can overlap with symptoms of Sever’s disease. Distinguishing between these conditions may require a clinical assessment.
Symptoms to Look For
Achilles-related discomfort may occur at the back of the heel or slightly above it. Children may describe stiffness, tenderness, or pain when running uphill, sprinting, or jumping.
Reducing aggravating activities, reviewing training demands, and following an appropriate rehabilitation plan can help manage symptoms. Sudden severe pain, marked swelling, or an inability to bear weight requires prompt medical assessment.
3. Plantar Fascia Pain
Understanding the Plantar Fascia
The plantar fascia is a strong band of connective tissue running along the bottom of the foot, helping support the arch. Repetitive loading can irritate this tissue and contribute to pain around the underside of the heel.
Although plantar fascia problems are more commonly discussed in adults, children can also develop pain in this area.
Common Symptoms
Symptoms may include tenderness underneath the heel, discomfort after running, and pain during the first steps after resting. The location and timing of symptoms can vary, so plantar fascia pain should not be assumed without assessment.
Management may include modifying high-impact activities, appropriate footwear, and exercises selected according to the child’s symptoms and physical needs.
4. Bone Stress Injuries
What Is a Bone Stress Injury?
Bone stress injuries occur when repetitive loading damages bone faster than the body can repair it. These injuries can develop when running volume or intensity increases too quickly, especially when recovery and nutrition are inadequate.
Although less common than Sever’s disease, bone stress injuries are important to recognise because continuing to run can worsen the condition.
Warning Signs Parents Should Recognise
A child may experience localised heel pain that becomes progressively worse with activity. Pain may eventually occur during walking or at rest, and the affected area may be particularly tender.
Persistent, focal, or worsening heel pain requires professional assessment. A clinician may recommend imaging if a bone stress injury or another significant condition is suspected.
Do not allow a child with suspected bone stress injury to continue running until they have received appropriate medical guidance.
5. Other Factors That May Contribute to Heel Pain
Sudden Increases in Training
Increasing running distance, speed, or frequency too quickly can place additional stress on growing tissues. This is particularly relevant when children return to sport after a school holiday, injury, or extended break.
Tight Calf Muscles
Reduced calf flexibility may increase discomfort during activities that repeatedly load the heel. However, tightness is not always the underlying cause, and stretching alone may not resolve the problem.
Unsuitable or Poorly Fitting Footwear
Shoes that are worn out, uncomfortable, or poorly fitted may contribute to discomfort during running. Children need footwear that fits correctly and suits their activity, but no particular shoe can guarantee injury prevention.
How Can You Help Prevent Heel Pain in Young Runners?
Increase Running Gradually
Introduce changes in running distance, speed, and frequency progressively. Avoid sudden increases in training demands, especially during growth spurts or after time away from sport.
Allow Adequate Recovery
Rest and recovery are essential for growing bodies. Include breaks between demanding sessions and avoid scheduling repeated high-impact activities when the child is already experiencing pain or fatigue.
Choose Comfortable, Well-Fitting Shoes
Check your child’s footwear regularly as their feet grow. Shoes should feel comfortable, fit properly, and provide suitable support for the activity. Replace footwear when it no longer fits or becomes excessively worn.
Build Strength and Flexibility
Age-appropriate calf strengthening, balance activities, and flexibility exercises may support a child’s ability to tolerate running. A paediatric physiotherapist can recommend exercises based on the child’s age, symptoms, and sporting demands.
Encourage Children to Speak Up About Pain
Children may hide symptoms because they want to keep playing or avoid missing a competition. Encourage them to report pain early and reassure them that taking a break when necessary is part of staying healthy.
When Should You Seek Professional Help?
Arrange a medical or physiotherapy assessment if your child’s heel pain persists, repeatedly returns, affects walking, or interferes with sporting activities.
Seek prompt medical attention if the pain is severe, follows a significant injury, causes an inability to bear weight, or is accompanied by substantial swelling. Fever, a hot or red heel, or unexplained night pain also warrants urgent medical evaluation.
A healthcare professional can assess the location of the pain, your child’s growth and activity history, movement patterns, and relevant physical findings. Imaging may be appropriate in selected cases, particularly when a fracture or another diagnosis is suspected.
Conclusion
Heel pain after running is relatively common in children, and Sever’s disease is a frequent cause in growing athletes. However, Achilles tendon irritation, plantar fascia problems, and bone stress injuries can produce similar symptoms.
The best approach is to identify the cause rather than assume all heel pain is related to growth. Gradual training progression, adequate recovery, suitable footwear, and early attention to symptoms can help children participate in sport more comfortably.
If your child’s heel pain persists or affects their everyday activities, seek professional advice. Early assessment and an appropriate management plan can help support recovery and a safe return to running.