Growing children have growth plates in their bones.
Since a growth plate is not as strong as bone, repetitive overuse or sudden-injury stress can occur when the tendon that attaches at or near it pulls on it, causing irritation and pain. This phenomenon is called apophysitis. This can occur within several body parts (knee, hip, elbow), but this article focuses on a specific type of apophysitis called Severs Disease or calcaneal apophysitis.
This is not usually related to a traumatic injury, but rather overuse. It is caused by repetitive stress to the foot, usually from running or jumping without allowing time for the body to recover from these repetitive micro-injuries.
The growth plate in the heel bone, known as the calcaneus, is most likely to be irritated in youth ages 7-14. It also is common during rapid growth periods such as growth spurts. Cleats, which often lack appropriate padding and arch support, can contribute to this problem.
The pain usually comes on slowly and becomes worse with activity. It will improve with rest and may be in either one or both heels. Sometimes children will walk or run on their toes to avoid putting pressure on their heels. Occasionally there may be some swelling on or around the heel.
X-rays are not always necessary but they will show the open growth plate of the heel bone. Because this growth plate is not in a joint, there is no risk of developing arthritis later in life with this injury.
Treatment for Severs Disease typically involves relative rest. The child does not have to completely stop all activity but should be allowed to play as tolerated. If children are limping or complaining of pain after practice or games, then they are not resting enough. Heel pads can be helpful, particularly in cleats. Anti-inflammatory medications such as ibuprofen can be helpful but I tend to only recommend that for games as I want the child to be able to recognize pain and back off if needed, particularly during practice. Make sure to consult with your doctor on how much ibuprofen to give your child as it varies based on age and weight. Stretching calf muscles can also be helpful and may be a part of prevention of this problem.
If you are unsure of what to do, consult with a board-certified sports medicine physician who can help guide you and your athlete back to the field.
Additional sources for insight:
Dr. Justin McCoy advances the health of athletes through SCL Health in Grand Junction, Colo. He is a member of the American Medical Society for Sports Medicine and the Performing Arts Medical Association. He also serves on the Western Colorado Concussion Alliance. Dr. McCoy provides comprehensive medical care to both non-athletes and athletes alike, spanning recreational to professional levels.