Heel Pain in Children: Plantar Fasciitis or Sever's Disease?

Parent watching a young child walk a few steps across a bright living room to observe their gait

Children rarely describe foot pain clearly. Often the first clue is a change in how they move.

Your child comes off the football pitch limping, or complains that their heel hurts after a long day at school. You look it up, and plantar fasciitis is the first thing that appears, because it is the best known cause of heel pain in adults. It is a fair guess, however it is often the wrong one.

In a growing child, most heel pain comes down to one of two conditions, and they are easy to mix up: plantar fasciitis and Sever's disease. They involve different tissues, they tend to hurt in different places, and the more common of the two by far is the one most parents have never heard of. Knowing which is which helps you respond sensibly, and our broader overview of children's foot pain sits alongside this guide.

This article explains what each condition is, how to tell them apart by location, age, and timing, and when a child's heel pain deserves a professional opinion. It is background to help you understand what you are seeing, not a way to diagnose it at home.

Quick answer: which one is it?

In children, heel pain is more often Sever's disease, an irritation of the growth plate at the back of the heel, than plantar fasciitis, which affects the tissue along the arch. Sever's tends to hurt at the back or sides of the heel and is sore when the heel is squeezed. Plantar fasciitis is felt more along the bottom of the foot, often sharpest with the first steps of the day. Because they overlap, only a professional exam can confirm the cause.

Two conditions, two different tissues

The confusion makes sense once you see what each condition involves, because both produce heel pain but for different reasons.

Plantar fasciitis

The plantar fascia is a thick band of tissue running along the bottom of the foot, from the heel forward to the base of the toes. It supports the arch and helps absorb load with every step. Plantar fasciitis is irritation of that band, usually where it attaches to the heel. It is very common in adults, and our main guide to plantar fasciitis explains why it tends to bite hardest with the first steps after rest. Children can develop it too, particularly older, sporty kids, but it is not the usual explanation for a young child's sore heel.

Sever's disease

Here is the one most parents do not know. In a growing child, the back of the heel contains a growth plate, an area of cartilage that is softer than bone and more vulnerable to repeated stress. Sever's disease, also called calcaneal apophysitis, is irritation of that growth plate. According to the American Academy of Orthopaedic Surgeons, it is one of the most common causes of heel pain in growing children, especially those active in running and jumping sports. Our dedicated guide to Sever's disease in children goes deeper on how it develops during growth spurts.

The location tells the story: plantar fasciitis irritates the arch tissue underneath, while Sever's disease irritates the growth plate at the back of the heel.

How to tell them apart

No parent can diagnose this at home, and you should not try to. But a few patterns can help you understand what you are seeing and describe it accurately to a clinician. Three things separate the two conditions most usefully.

Where it hurts

This is the most telling clue. Sever's disease is usually felt at the back or sides of the heel, and the classic sign is pain when the heel is gently squeezed from both sides, like a squeeze test. Plantar fasciitis is felt more toward the bottom of the foot, along the arch and the underside of the heel rather than the back of it.

The child's age and stage

Sever's disease only happens while the growth plate is still open, so it typically shows up in children and young adolescents roughly between ages 8 and 14, often during a growth spurt. It disappears for good once the growth plate matures into solid bone. Plantar fasciitis is not tied to growth plates, so it can occur at any age, which makes it relatively more likely in older teenagers whose feet have finished growing.

When it flares

Plantar fasciitis often produces sharp pain with the first few steps in the morning or after sitting, easing as the foot warms up. Sever's pain is more closely tied to activity itself, flaring during and after running and jumping and settling with rest. The overlap is real, though, so timing supports the picture rather than proving it.

Symptoms parents actually notice

Whichever condition is behind it, children are not reliable narrators of their own pain. A young child may not point to the right spot, and often simply avoids an activity rather than complaining. The behavioural signs are usually clearer than any description, and they apply to both conditions:

Limping, or walking on the toes or the outer edge of the foot to offload a sore heel.
Reluctance to run, jump, or join activities they normally enjoy, or asking to stop early.
Complaints of heel pain after sport or a long day that ease with rest.
Rubbing or holding the heel after activity, or asking to be carried.
Pain in both heels, though often one is worse than the other.

If the discomfort tends to follow training, our guide to kids foot pain relief for flat feet covers what to watch for in young athletes. And not every childhood ache is one of these two conditions, since ordinary growing pains and other causes exist as well.

What raises the risk

Both conditions share several contributing factors, which is another reason they travel together. Growth spurts leave the calf and the tissues at the back of the leg tight, increasing the pull on the heel. A sudden jump in sport, like the start of a season, piles on repetitive impact faster than a young foot can adapt. Foot shape matters too, and children with flat feet can place extra strain on the arch and heel. Worn out, unsupportive shoes and long spells on hard surfaces add to the load. None of these makes pain inevitable, but they help explain when and why it appears.

When to have a child's heel pain checked

Most mild heel aches settle within a few days of lighter activity. Some situations call for a professional opinion rather than waiting it out. See a pediatrician or podiatrist if your child has:

Heel pain that persists beyond a week or two, or that keeps returning.
Pain that is worsening rather than improving, or that causes a limp.
Pain that followed a specific injury, fall, or twist.
Swelling, redness, warmth, or pain that wakes them at night.
Pain that stops them taking part in normal play, school, or sport.

A proper assessment matters precisely because these two conditions are treated differently, and other causes need to be ruled out. A clinician can examine the heel, apply the squeeze test, ask about activity and growth, and order an X-ray if needed. Use this article as background for that conversation, not as a replacement for it.

Supportive steps that generally help

While the cause is being sorted out, and for many everyday aches, the same gentle measures help with both conditions. Easing off high-impact activity for a short while lets irritated tissue calm down. Gentle calf and foot stretching, guided by a professional, reduces the tightness that pulls on the heel. Supportive, well-fitting shoes with a cushioned heel help a great deal, and replacing worn out shoes is an easy win.

Cushioning and light arch support inside the shoe can take some load off the heel and arch through the day. For children the goal is comfort during activity, not correcting anything, and any insole should sit alongside your child's doctor's guidance rather than replace it. Supportive insoles made for school and sport, such as those in our notes on arch support for school and sports, are one practical option among several.

A supportive insole option for active kids

If you and your child's doctor decide added support may help, a structured insole sized for children's feet can provide arch support and heel cushioning during school days and sport. It is a comfort measure that eases load on the heel, not a treatment for any specific condition.

Footminders Kids

Structured orthotic insoles sized for children's feet, providing arch support and heel cushioning for school shoes and sports shoes. Designed to help reduce the load on growing feet during active days.

View Kids Insoles

Related guides

FAQ

Is my child's heel pain more likely to be plantar fasciitis or Sever's disease?

In a growing child, Sever's disease is the more likely of the two, especially in active kids roughly between ages 8 and 14. Sever's is an irritation of the growth plate at the back of the heel, while plantar fasciitis affects the tissue along the bottom of the foot and is more common in adults and older teens. The location of the pain is the biggest clue, but the two overlap enough that only a professional exam can confirm which one it is.

How can I tell the difference at home?

You cannot confirm it at home, but you can look at patterns. Pain at the back or sides of the heel that hurts when the heel is gently squeezed points toward Sever's disease. Pain along the bottom of the foot and arch, often sharp with the first steps of the morning, leans toward plantar fasciitis. The child's age helps too, since Sever's only occurs while the growth plate is still open. Treat these as clues to describe to a clinician, not a diagnosis.

Why is Sever's disease so much more common in children than plantar fasciitis?

Because of the growth plate. In children and young adolescents, the back of the heel has an area of cartilage that is still developing and is softer and more vulnerable to repeated stress than the surrounding bone. Running and jumping load that area heavily, especially during growth spurts, which is why Sever's disease is one of the most common causes of heel pain in this age group. Once the growth plate matures into solid bone, Sever's disease no longer occurs, whereas plantar fasciitis can happen at any age.

Should my child stop playing sports until the pain goes away?

A short reduction in high-impact activity often helps both conditions settle, so easing back for a few days is sensible when pain appears. Whether a longer break is needed depends on the cause and the severity, which a professional can advise on. If pain is mild and there is no limp, gentle activity may be fine, but pain that is persistent, worsening, or causing a limp is a reason to have it assessed before returning to full training.

Can insoles help with either condition?

Insoles are a comfort and support measure, not a cure for either condition. Cushioning and arch support can take some load off the heel during school and sport, which may make an active child more comfortable while the underlying issue is managed. For Sever's disease in particular, heel cushioning is a commonly suggested support. Any insole should be used alongside advice from your child's doctor, not as a substitute for a proper assessment, especially if the pain is persistent or worsening.

Medical references

Final takeaway

When a child's heel hurts, plantar fasciitis is the name that comes to mind, but Sever's disease is usually the better answer, and the two are told apart mainly by where the pain sits and how old the child is. Notice how your child moves, note where and when it hurts, ease off high-impact activity for a while, and check that their shoes are supportive. If the pain lingers, worsens, causes a limp, or follows an injury, have it assessed. Naming the cause correctly is what points you to the right relief.