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If your school-age child has heel pain after practice or playing in the playground, the most common cause is growth, not a disease in the frightening sense of the word. In active children aged about 8 to 15, it is usually Sever’s disease (calcaneal apophysitis): irritation of the heel bone’s growth area, which generally goes away on its own once the child has finished growing. Below, you’ll learn how to recognize the typical symptoms, what you can do at home, which signs you shouldn’t ignore, and what kind of footwear can help your child take softer steps while recovering.

TL;DR

• The most common cause of pain at the back of the heel in children aged 8 to 15 is Sever’s disease, which results from growth and strain, not an injury or “wear and tear.”
• Less running and jumping, icing, calf stretches, and a gradual return to sports can help. Give pain medication only as directed by a pediatrician.
• See a pediatrician as soon as possible if your child has heel pain at night or at rest, if the heel is swollen, your child has a fever, or the pain makes it impossible for them to walk normally.
• Slippers won’t treat the underlying growth-related cause, but they can be kinder to the heel: soft, roomy, breathable, with a flexible sole and the right length.

Contents

• Why a child’s heel hurts: growth that sometimes hurts
• Other causes of heel pain
• When to see a pediatrician and when to seek emergency care
• What you can do at home
• What an examination usually involves
• Footwear and slippers: what helps and what doesn’t
• Our perspective: a gentle step through the growing years
• Slippers for school and home that don't make heels hurt
• Frequently asked questions
• Sources

Why a child’s heel hurts: growth that sometimes hurts

Children’s feet grow in spurts. At the back of the heel bone is a growth area that closes only in the teenage years. The Achilles tendon attaches there and connects the heel to the calf muscles. When bones grow faster than muscles and tendons lengthen during a growth spurt, the tendon pulls harder on the still-immature growth plate. If a child also runs, jumps, or plays soccer a lot on hard surfaces, this area becomes irritated and painful.

A review article in the StatPearls collection describes how Sever’s disease most often occurs in active children and adolescents between the ages of 8 and 15, during a period of rapid growth, and accounts for 2 to 16% of all musculoskeletal problems in children. The heel bone’s growth plate usually does not close until around age 14, and symptoms generally ease as the skeleton matures.

Scottish clinical guidelines for doctors go a step further and reassure parents: the name “disease” is misleading, since it’s more a side effect of growth than an illness. UK NICE guidelines also describe it as a condition that resolves on its own, for which reassurance and avoiding activities that trigger pain are most important.

It’s not your fault, and it’s not your child’s fault. It doesn’t mean the sport was the wrong choice, nor that you bought the wrong shoes. It is a sign, however, that the body needs a little more gentleness during this period.

How to recognize the typical pattern

Sever’s pain has a fairly recognizable pattern. The child points to the back or underside of the heel, not the toes or the arch of the foot. The pain appears while running, jumping, or after practice; the foot may feel stiffer in the morning or after sitting for a long time, and the pain eases with rest. Both heels are often affected, and after a game the child may limp or walk more on their toes to take pressure off the heel.

Leg pain in school-age children is not uncommon. In an article in the journal Slovenska pediatrija, the authors state that lower-limb pain affects up to 16% of schoolchildren, and they also list Sever’s disease among the common causes in active children. So it’s good to know what’s usual—and what isn’t.

Other causes of heel pain

Sever’s disease is the most common cause, but it’s not the only one. A review article on heel pain in children emphasizes that doctors first ask exactly where it hurts, whether there was an injury or puncture, and whether the child has a fever or is losing weight, since these answers help distinguish harmless causes from those that need more prompt care.

Other possibilities include:

• plantar fascia irritation, when the pain is underneath the heel and toward the arch of the foot, more often in older teenagers;
• Achilles tendon irritation, when the pain is slightly higher, above the heel;
• a stress fracture of the heel bone after heavy, repeated strain;
• an injury or foreign object, such as stepping on something sharp or landing from a height;
• a bone or joint infection, which is rare but urgent, usually accompanied by fever and feeling unwell.

In toddlers who can’t yet explain well what hurts, the symptoms are less typical. Sever’s disease is characteristic of school-age children, so heel pain in a preschooler warrants a pediatrician’s examination sooner rather than later.

When to see a pediatrician and when to seek emergency care

Most heel pain isn't dangerous, but some signs shouldn't be ignored. South Australia's SA Health guidelines recommend immediate emergency care if the child appears unwell, has a fever, or an infection is suspected. In Slovenia, this means going to an on-call pediatric clinic or emergency department, and outside office hours, calling 112 if the child is very unwell.

Call your child's pediatrician promptly if you notice:

• pain at rest or at night that wakes the child;
• sudden pain without an injury;
• swelling, redness, or a warm heel;
• marked tenderness in one spot;
• an injury, fall, or suspicion of a foreign object in the foot;
• the child cannot walk normally because of the pain or cannot put weight on the foot.

See a pediatrician if the pain doesn't follow the usual pattern, gets worse, or doesn't ease despite two weeks of rest and basic measures. If in doubt, it's always better to get it checked than to guess.

What you can do at home

For typical Sever's disease pain, a single magic solution rarely does the trick. A combination of small, consistent steps can help, as described in the Scottish guidelines for heel pain in children:

1. Reduce the strain. For a while, cut back on or stop running, jumping, and sports on hard surfaces. Complete rest isn't necessary: the child can stay active up to the point before pain starts.
2. Choose gentler activities. In Jana magazine, experts recommend swimming, water exercises, and other activities that reduce the load on the heel bones. Cycling is also suitable for many children.
3. Apply ice after activity. Place a cold pack wrapped in a thin cloth on the heel for 10 to 15 minutes. Never place ice directly on the skin.
4. Stretch the calves. Gentle daily stretching of the calf muscles and Achilles tendon reduces pulling on the growth plate. A physical therapist can show you how, if your pediatrician refers you.
5. Use medication only as directed. Give pain medication only if recommended by a pediatrician, and at the prescribed dose.
6. Return to sports gradually. Once the pain eases, the child can start with shorter training sessions and increase them according to how they feel. Returning too quickly often irritates the heel again.

Also be prepared for the pain to return during the next growth spurt. This is not a treatment failure, but part of growing up. According to the same guidelines, the problem usually does not return once growth is complete.

What an examination usually involves

Many parents expect an X-ray. With typical symptoms, it is often not needed. SA Health guidelines state that imaging is especially appropriate in cases of injury, swelling, pronounced localized tenderness, sudden pain without an injury, or pain at rest and at night. A good conversation and examination are more informative than an image: when the pain started, which activities trigger it, whether the foot is stiff in the morning, and how the child walks.

Depending on the findings, your pediatrician may refer you to a physical therapist for stretching and strengthening exercises, to an orthopedist, or for further tests. It’s also important to know what isn’t necessary: for Sever’s disease, surgery is not needed; treatment is conservative and focuses on relieving pain and gradually returning to activity.

Footwear and slippers: what helps and what doesn’t

This is often where people get stuck. When a child’s heel hurts, the first thought is that their shoes are to blame, and the second is that they need “orthopedic” or “corrective” slippers. Slovenian experts advise keeping a cool head. Orthopedist Borut Kovačič from the University Medical Centre Ljubljana told Žurnal24 that children need soft, comfortable, roomy footwear, and that healthy feet are not corrected with orthopedic shoes. Revija za Moje zdravje makes a similar point: studies involving large numbers of children have shown that healthy children’s feet do not need orthopedic footwear.

So slippers won’t cure Sever’s disease, since it is caused by growth. But they can help prevent further irritation to the heel at home and at school. Children spend many hours in slippers: in class, in after-school care, and at home after school. A stiff, too-narrow, or too-short slipper that slips and rubs won’t add to their comfort. A soft, well-fitting slipper gives the heel a little peace.

The child’s comfort should always come first. If a child with heel pain feels more comfortable in slippers with a little extra cushioning under the heel on hard floors, take that into account. If the child has been given an insole prescribed by an orthopedist or physiatrist, choose slippers that fit the insole well, and check your choice with the professional who prescribed it.

A useful overview of how to choose footwear that won’t irritate the feet is also available in this guide on how to choose the right children’s footwear for health and comfort. For more detail on measuring and fit, we’ve gathered tips in our guide to how to choose slippers for children, and on materials in our guide to breathable materials in children’s slippers. General tips for healthy foot development can be found in our article on children’s foot health.

Our perspective: a gentle step through the growing years

The name Copa cop came from a sound every family knows: the soft footsteps of children across wooden floors as they run into the kitchen. We love that sound, so it hurts us every time a mother or father writes to say that their child is limping after practice because of heel pain.

Let’s be honest first: slippers are not a cure. Sever’s disease pain comes from growth, and no slipper can affect it, including ours. If your child has pain at night, a swollen heel, or a fever, take them to a pediatrician, not a store.

But we can take care of what’s in our hands. We make our slippers by hand in Slovenia from natural, breathable materials, with ergonomic, flexible soles, because we believe children’s feet develop best through movement and comfort, not in a hard shell. When choosing slippers for a child with heel pain, we recommend the same things we would recommend for our own children: measure the foot, leave some room to grow, check that the slipper doesn’t slip or rub, and watch how your child walks in it. If they walk comfortably and don’t notice the slipper, you’ve made the right choice.

And remember: this phase will pass. The heel will settle down, the child will be running on the playground again, and the slippers will quietly go copa cop down the hallway once more.

— A line

Slippers for school and home that don't make heels hurt

If you’re looking for new slippers for a schoolchild, take a look at our school slippers, such as the breathable Urban textile slippers, and browse our full range of children’s slippers for home. They are all handmade in Slovenia from natural, breathable materials. If the size isn’t right, you can exchange or return them. Shipping is free on orders over €50, and if you’re in a hurry, you can choose priority order processing for €5.

Frequently asked questions

Can a child with heel pain still train?

Usually, yes, but at a reduced level and only up to the point before pain starts. During a more severe episode, it helps to replace running and jumping with swimming or cycling for a while. The coach should know about the problem so they don’t push the child to train at full intensity, and the return to full activity should be gradual.

How long does Sever’s disease last?

An episode of pain usually settles within a few weeks with rest and stretching, but it may return during the next growth spurt. It goes away completely once the heel’s growth plate closes, which usually happens during the teenage years. If the pain gets worse despite these measures, have a pediatrician examine the child.

Does a child with heel pain need orthopedic insoles?

Not necessarily. According to Slovenian orthopedists, healthy children’s feet do not need orthopedic footwear without a clear reason. A pediatrician, orthopedist, or physiatrist should decide whether insoles are needed after an examination, rather than you buying them on your own.

Are barefoot slippers suitable for a child with heel pain?

Flexible, roomy slippers are a good choice for healthy feet, but when the heel hurts, the child’s comfort is what matters. If the child’s heel hurts more on hard floors, choose slippers with a little more cushioning under the heel and monitor them for a few days. If in doubt, consult a physiotherapist or pediatrician.

Sources

• Sever Disease (Calcaneal Apophysitis), StatPearls, NCBI Bookshelf
• Heel Pain in Children, Advice for Referrers, NHSGGC
• Common musculoskeletal presentations in children: Heel pain, NICE CKS
• Lower-limb pain in children and adolescents, Slovenska pediatrija
• A Review of Pediatric Heel Pain, PMC
• Heel Pain, Paediatric CPC, SA Health
• Sever’s disease, the most common cause of heel pain in children, Revija Jana
• An orthopedist from UKC Ljubljana advises on what footwear to buy for your child, Žurnal24
• Orthopedic footwear and the proper development of a child’s foot, Revija za Moje zdravje
• How to choose the right children’s footwear for health and comfort

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