Apophysitis is irritation of a growth plate where a tendon attaches to bone. In the foot, it most often affects the heel (Sever’s disease) and the outside of the foot (Iselin’s disease). This page explains foot apophysitis in growing children and how orthotic therapy and activity changes may help.
An apophysis is a growth plate that acts as an attachment point for a tendon. During growth, repeated pulling from the tendon during sport can irritate the area, causing pain known as traction apophysitis. It is common in active children and usually settles once growth is complete.
The two most common types in the foot are Sever’s disease at the back of the heel, and Iselin’s disease at the base of the fifth metatarsal on the outer edge of the foot, where the peroneus brevis tendon attaches. Iselin’s disease is less common and often occurs in children around 9 to 14 years of age who play running, jumping and cutting sports.
Similar growth-plate irritation can occur at the knee in Osgood-Schlatter disease. Management focuses on reducing load on the irritated area, with orthotic therapy, footwear changes and activity modification commonly discussed.
Children may not always describe symptoms clearly, so parents often notice changes in walking, activity or footwear first. Common signs include:
A podiatry assessment considers your child’s growth stage, symptoms, foot posture, walking pattern, activity levels and footwear.
Considers age, growth stage and sports involvement.
Identifies the location of tenderness and aggravating movements.
Assesses how load is distributed through the foot.
Training volume, surfaces and footwear.
May be considered to rule out a fracture after an injury.
Management is tailored to your child’s age, activity level, foot posture and goals.
Orthotic therapy may be considered to reduce load on the irritated growth plate. For Iselin’s disease, orthoses may be designed to reduce excessive pressure and strain along the outer foot; for Sever’s disease, heel raises and cushioning are often used.
Orthoses work best alongside footwear changes, short-term load reduction and a graded return to sport.
May help reduce strain on the growth plate during activity.
Temporarily reducing aggravating activities, then gradual return.
Stretching for tight calf and lower-leg muscles.
Progressive strengthening once pain settles.
Shoes and boots that do not press on sore areas.
Strapping may be discussed for short-term support.
Learn more about orthotic therapy, strengthening, stretching and strapping, or view all treatments. Related kids conditions include Sever’s Disease, Osgood-Schlatter Disease, recurrent ankle sprains, high arches, plantar heel pain.
Assessment can help confirm the likely cause of pain and plan a return to sport.
Please see your GP or seek medical care if pain follows a fall or twisting injury, if there is significant swelling or bruising, if your child cannot bear weight, or if pain is present at night.
Iselin’s disease is a traction apophysitis at the base of the fifth metatarsal on the outside of the foot. It is a growth-related condition seen in active children.
No. Apophysitis generally settles once the growth plate matures, although symptoms can come and go during growth.
Orthoses and heel raises may help reduce load on the irritated growth plate as part of a broader management plan.
A fracture usually follows a specific injury with sudden pain and swelling. If an injury has occurred, medical assessment and imaging may be needed.
We create a calm, supportive space to help children feel comfortable during assessment.
Where appropriate, prefabricated and custom foot orthoses are discussed based on assessment findings.
We help parents understand what is normal, what may need monitoring, and what can be supported.
Our clinic is located at 1/50 Kitchener Parade, Bankstown, and sees families from across Sydney, including Bankstown, Condell Park, Padstow, Revesby, Lakemba and Belmore. Visit our children’s podiatry page for more kids foot conditions, read about our clinic, or contact the clinic to make an appointment enquiry.
This information is general in nature and is not a substitute for individual assessment and advice. Outcomes vary between children. If you are concerned about your child’s health, please consult your GP or a registered health practitioner.
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