Every parent knows that their children's feet grow at alarming speed. One day you buy them new shoes and the next day the shoes are too tight. It's enough to make you want to send them into the world barefoot.

The never-ending growth spurts in children's feet are due to the fact that the foot is one of the first parts of the body to grow to full size. This speedy growth is accompanied by uneven development in the lower leg and ankle, making muscles and tendons very tight and the heel less flexible. This inflexibility exposes the heel to injury and places a lot of stress on the growth plate, a soft area at the end of the heel which eventually fuses with the heel bone (calcaneus).

Sever's Disease (calcaneal apophysitis), the most common cause of heel pain in children, is a painful inflammation of the heel's growth plate. The heel bone is not fully developed until age 14 or 15, and is constantly adding new bone at the growth plate (physis). When the growth plate is subjected to a lot of repetitive stress, like that in athletics, inflammation can develop.

It should be noted that the symptoms of heel pain in adults are different from heel pain in children. In adults, heel pain is usually at its worst in the morning and decreases or subsides as the tissue warms up with activity. But in children, heel pain usually doesn’t diminish as the child moves around – in fact it may get much worse.

Fortunately, Sever’s Disease is a temporary condition and with rest and treatment, symptoms will usually subside within 8 weeks. If the condition persists, it's important that your child sees a podiatrist for a thorough evaluation and treatment plan. The risk of recurrence of Sever’s Disease diminishes with age and typically doesn't occur after 15, when foot growth is complete and the growth plate has fused to the rest of the heel bone.

Factors which contribute to Sever's Disease

• Obesity
• High level of physical activity
• Long periods of standing which put pressure on the heel
• Flat feet or a high arch
• Pronated foot - one which rolls inward when walking
• Short leg syndrome (one leg is shorter than the other)

Symptoms of Sever's Disease

• Pain or tenderness at the back of the heel, and/or along the side and bottom of the heel, extending to the arch
• Redness and swelling in the heel
• Difficulty walking or running
• Feet are stiff upon waking
• Heel pain increases with activity
• Child walks on tiptoes, limps, or favors one foot over another

To relieve your child's heel pain

• Rest
• Ice and elevate the foot
• If approved by physician, use over the counter pain medicine to control pain
• Suspend athletic activities until pain subsides
• Wear athletic shoes which fit properly and pad the foot
• Of obese, begin weight management program
• Stretching exercises for the heel and hamstrings (under supervision of physical therapist)
• No high heeled shoes

If your child complains about heel pain, don’t take it lightly, as early intervention and treatment by a podiatrist is key to a continued healthy development.