Why Does My Heel Hurt? Answers for Young Athletes

Dr. Juliet DeCampos  (Andrews Institute, Gulf Breeze, Florida)

Although he was resistant to most injuries, even Achilles could hurt his heel.  It is usually the first part of the body to hit the floor in the morning and a main impact point in runners and jumpers, making it a common area injured by young athletes.  Other risk factors are rapid growth, hard surfaces and, unfortunately, obesity.   Pain at the bottom or back of the heel is a warning sign not to be ignored.

The first sign is usually limping, often noticed by parents.  Even without a child complaining, limps have to be investigated to determine the cause, which can be as simple as a blister or as complex as a stress fracture.  Toe walking and pain the day after intense practice or games are other common complaints.  

Heel pain from ages 8- 13 (girls) or 15 (boys) due to inflammation of the growth plate (or “physis”) of the heel in early puberty is referred to as calcaneal apophysitis, which is sometimes called Sever’s disease.  New bone forms to accommodate growth in the heel at this strip of cartilage. This is usually caused by tight tendons, especially of the Achilles tendon, in addition to overuse, repeated pounding or excessive force on the Achilles tendon causing inflammation or pain. It is temporary, but can reoccur with another growth spurt. There are no long term effects.

Teenagers may have closed growth plates, but can still have pain in the heel from more adult conditions like tendinitis, bursitis, bone bruises, fractures, or even from arch problems like plantar fasciitis.

Treatment of heel pain starts with rest.  Ice and anti-inflammatories like over-the-counter ibuprofen and naproxen may decrease pain, but if it persists after 7-10 days, then evaluation by a specialist is in order.  X-rays, physical therapy, bracing, walking boots or even casting may be needed. Sudden severe pain following injury or an open wound (cut, bite or puncture) should be treated as a medical emergency. 

Tips to prevent severe heel pain from overuse include stretching, wearing the correct shoe, and taking necessary rest from intense pounding sports.  Appropriate, well-fitting shoe wear specific for each sport are an important part of the official “uniform,” and can prevent heel problems.  As the foot typically grows continually until adolescence, feet should be measured for each new sport and new shoe to avoid problems.  Some children with “flat feet” may be pain free, while others have heel and arch pain which would benefit from arch supports, which also must be re-fitted for growing feet. Impact can be lessened by appropriate cushioning or padding.  

Water sports require foot protection to avoid infections from open wounds. Cleated shoe wear should also be minimized. Specializing in one sport year round, now common, may cause unchanging stress to one body part and puts young athletes at risk for muscle imbalances.  Time off from that specific sport may be necessary to overcome overuse problems.