Plantar fasciitis in children and adolescents
Plantar fasciitis is a cause of pain in the sole of the foot, especially near the heel. The plantar fascia is a strong band of tissue that connects the heel to the front of the foot and helps support the arch. In older children and adolescents it can appear with sports overload or tightness in the muscles at the back of the leg. Treatment is usually conservative.
- Typical age
- Adolescents and young athletes; less common in young children
- Also known as
- Plantar heel pain · Plantar fasciopathy · Inflammation of the plantar fascia
What is it?
The plantar fascia is a band of fibrous tissue that runs from the underside of the calcaneus (the heel bone) to the front of the foot. It helps maintain the arch and helps the foot absorb and transmit forces when walking, running and jumping.
Plantar fasciitis occurs when this structure is overloaded and becomes painful, usually where it attaches to the heel. Although it is traditionally described as inflammation, persistent cases can also involve degenerative changes and a reduced ability of the tissue to tolerate load.
It is less common in children and adolescents than in adults. It can appear in young people who play sports involving running and jumping, especially after a sudden increase in training intensity or frequency. Tightness of the Achilles tendon and the muscles at the back of the leg, as well as certain biomechanical factors, can contribute to the symptoms.
It is important to distinguish it from other causes of heel pain related to growth, especially Sever’s disease, which affects the growth area of the heel bone. Although both can cause pain in a nearby area, their origin and clinical examination are different.
Signs parents may notice
The most common symptoms are:
- Pain under the heel or along the inner part of the sole.
- Discomfort with the first steps in the morning or after sitting for a while.
- Pain that returns or increases when running, jumping or walking for long periods.
- Tenderness when pressing where the plantar fascia attaches to the heel.
- Stiffness or a feeling of tightness in the sole and the back of the leg.
- Needing to cut back on sport because of the discomfort.
In some adolescents, the pain eases once they start walking and increases again after prolonged activity. If symptoms persist, they can limit both sport and everyday activities.
When to see a specialist
An assessment by a paediatric orthopaedic specialist is advisable when the pain persists, keeps coming back or limits sport.
See a specialist especially if:
- The pain does not improve after temporarily reducing activity.
- The adolescent limps or has difficulty putting weight on the foot.
- The discomfort also appears at rest or at night.
- There is significant swelling, redness or local warmth.
- The pain starts suddenly after an injury.
- There is fever, general malaise or severe, worsening pain.
When is it urgent?
If the child cannot put weight on the foot or has severe pain after an injury, they should be seen urgently to rule out a fracture or another significant injury.
How is it diagnosed?
The diagnosis is mainly based on the clinical history and physical examination. The specialist asks where the pain is, when it started, what activities the child does and how the discomfort changes with exercise and rest.
The examination includes palpating the attachment of the plantar fascia at the heel, assessing ankle mobility and Achilles tendon tightness, and observing the shape of the foot and the walking pattern.
Imaging is not always necessary. If the picture is typical and the examination fits, a clinical assessment may be enough. With persistent pain, atypical symptoms or suspicion of another injury, X-rays or an ultrasound may be requested. MRI is reserved for selected situations where other possible causes need to be investigated.
In childhood it is especially important to rule out Sever’s disease, bone stress injuries and other causes of heel pain before attributing the symptoms to plantar fasciitis.
Treatment
Conservative treatment
Most cases improve with conservative measures. The aim is to reduce the load on the plantar fascia and gradually restore tolerance to activity.
1. Adjusting sports activity
Running, jumping and activities that cause pain should be reduced temporarily. It is not always necessary to stop all sport: alternative activities that do not cause discomfort can be continued.
2. Stretching
Gentle stretching of the plantar fascia and the muscles at the back of the leg can help reduce tension on the heel. Stretches should be progressed gradually, without causing severe pain.
3. Physiotherapy
Physiotherapy may include mobility exercises, stretching, strengthening of the foot and leg muscles and a controlled progression of sports load. In persistent cases, the physiotherapist may consider complementary treatments depending on the examination and the patient’s characteristics.
4. Footwear and insoles
Comfortable footwear with good cushioning and adequate support is recommended. Avoiding walking barefoot on hard surfaces can help when the pain flares up.
Heel cups or insoles can be useful for some patients, especially if there are associated biomechanical factors. They are not needed routinely and should be individualised.
5. Local cold
Applying cold, wrapped in a cloth, for about 10–15 minutes can relieve discomfort after activity. Ice should never be placed directly on the skin.
6. Complementary treatments
If the pain persists despite the usual measures, it is important to review the diagnosis and the rehabilitation programme. Some physical therapies may be considered on an individual basis, although the specific evidence in children is limited and not all have shown a clear benefit.
Shockwave therapy is not a usual first-line treatment in children and, if considered at all, should be reserved for selected cases under specialist assessment.
Surgical treatment
Surgery is exceptional in children and adolescents with plantar fasciitis. Before considering an operation, the diagnosis must be confirmed and a well-conducted conservative treatment must have failed over a sufficient period.
In very selected, persistent cases, procedures on the plantar fascia or on structures contributing to excessive tension may be considered, but they are not needed in the vast majority of growing patients. The decision must be individualised, taking into account skeletal maturity, the cause of the pain and the risks of each procedure.
Outlook and recovery
The outlook is usually good, although recovery can be gradual. How long it takes depends on the severity of the symptoms, how long the pain has been present and how well sports activity can be adjusted.
As a general guide:
- First 2–3 weeks: adjusting activity, measures to relieve pain and starting gentle exercises.
- Over the following 4–8 weeks: progressing mobility and strength exercises, depending on the clinical response.
- School: can usually continue as normal, as long as the pain allows comfortable walking.
- Return to sport: when the adolescent walks without pain, tolerates running and jumping exercises and does not have more discomfort after activity.
Some cases improve within a few weeks, while persistent ones may need several months of treatment and follow-up.
Return to sport should be gradual. If the pain comes back when training intensity increases, it is advisable to reduce the load temporarily and review the progression with the specialist.
This page is for general information and does not replace an assessment by a specialist. If you are worried about your child's foot, talk to their paediatrician or book an appointment.