From the clinic: heel pain in a young Irish dancer

Heel pain is common in active children, particularly during periods of growth. This young Irish dancer came to see me with pain at the back of both heels, worse on the left. Dancing was the main trigger, but walking, PE and netball had also become uncomfortable. After a dance session, the pain could take around three days to settle.

The symptoms had become much more noticeable after returning from a break of several weeks for exams. On returning to a long dance session, the heels were suddenly being asked to tolerate more impact again. Trainers felt more comfortable than school shoes or walking barefoot as is common.

What was causing the pain?

The history and examination were consistent with calcaneal apophysitis, often called Sever’s disease. Despite its name, it is not a disease. It is pain arising around the developing part of the

heel bone, where repeated running and jumping can place stress during growth.

Both heels were tender on examination. Balance, heel raises and foot control were good, and there was no marked flat foot or hypermobility that needed correcting. That matters: treatment should address what is actually contributing to the child’s symptoms, rather than assuming every painful heel needs a custom orthotic.

My approach: reduce the load, keep the child moving

Advice for Sever’s often includes rest and calf stretching. Both can have a place, but I do not routinely start calf stretching while the heel is still painful. Stretching pulls through the Achilles tendon onto the sensitive area at the back of the heel. I prefer to settle that irritation first, then consider gentle stretching if calf tightness is present and thought to be a contributing factor.

I also try to avoid telling an active child to stop everything when a manageable reduction will do. For this dancer, the starting plan was to cut aggravating activity by around half for three weeks. That gives the heels a chance to settle while preserving some participation in dancing and everyday activity. If symptoms were not improving, we would reduce the load further for another three weeks.

The response after activity is a useful guide. Pain that remains substantially worse for days afterwards suggests the current amount is still too much. As symptoms improve, dancing and other impact activities can be built back up gradually.

Making each step more comfortable

We also planned heel lifts beneath the insoles of both trainers and school shoes, alongside continued use of comfortable trainers at school. The aim was to reduce strain at the back of the heel and make walking more comfortable. We discussed avoiding barefoot time and very flat shoes while symptoms were active, and considering better cushioned trainers as the current pair were well worn.

Paracetamol could be used when needed, following age appropriate dosing advice. Pain relief should support comfort, rather than be used to push through a dance session that reliably causes several days of pain.

If this combination of load reduction and footwear changes did not help, I would reassess and consider whether a more tailored custom orthotic insole or another treatment was warranted. Follow-up could be by email if things were progressing well, with a review in clinic if symptoms worsened or failed to improve.

Calcaneal apophysitis can flare during growth, so management may need adjusting more than once. The reassuring news for this family was that it is generally a temporary condition and is not expected to cause lasting damage to the heel.

The goal is not to take sport away from a child. It is to find a level their heel can tolerate now, settle the pain, and guide them back towards the activities they enjoy.

About the author

Mr Liam Stapleton MSc, PGCert, PGDip, FFPM RCPS(Glas), FRCPodM is a Advanced Practice Podiatrist Prescriber and Specialist in Podiatric Sports Medicine.

His postgraduate qualifications include Independent Prescribing, Musculoskeletal Ultrasound, Advanced Clinical Practice, the Theory of Podiatric Surgery and Podiatric Sports Medicine.

If your child is struggling with heel pain, you can book an assessment with Kent Sports Podiatry at one of our clinics across Kent.

Call: 01622 961005

Book online: www.kentsportspod.com/online-booking