Richmond & Kensington, London
Growing Pains & Foot Pain in Children
Paediatric Gait & Foot Health Assessment
Not all childhood leg and foot pain is "just growing pains." Knowing what is normal, what needs monitoring, and what requires treatment is the first step — and that starts with an accurate assessment by an experienced paediatric podiatrist.
HCPC Registered
Paediatric Gait Specialist
Video Gait Analysis
No Referral Needed
"Growing pains" is a term used loosely to describe recurrent musculoskeletal pain in children — typically aching or throbbing discomfort in the legs, often at night or after active days. Despite the name, there is no evidence that pain is directly caused by bone growth. The likely mechanisms involve muscle fatigue, altered biomechanics, hypermobility, and reduced pain threshold — all of which may be influenced by foot posture and gait.
Growing pains affect an estimated 10–30% of children, usually between the ages of 3 and 12, and are generally benign and self-limiting. However, the term is also used — incorrectly — as a catch-all for childhood limb pain, and it is important not to dismiss pain that has a specific, identifiable, and treatable cause. A number of distinct paediatric foot and lower limb conditions are commonly labelled as "growing pains" when they are in fact something else entirely.
Heel — Growth Plate
Sever's Disease
Typical age: 8 – 14 years
Inflammation of the calcaneal apophysis (heel growth plate) at the Achilles tendon insertion. The most common cause of heel pain in active children. Triggered by repetitive traction at the growth plate during periods of rapid growth and sport. Pain is felt at the back of the heel, worsened by running and jumping. Responds well to load management, calf stretching, and heel lifts.
Foot — Structure
Paediatric Flat Feet
All ages — assess if symptomatic
A degree of flat foot is normal in young children and typically resolves as the arch develops through early childhood. Persistent symptomatic flatfoot — with pain, fatigue, or altered gait — may require assessment. Rigid flatfoot at any age warrants investigation to exclude tarsal coalition or other structural causes.
Knee — Growth Plate
Osgood-Schlatter Disease
Typical age: 10 – 15 years
Traction apophysitis at the tibial tuberosity — where the patellar tendon attaches below the kneecap. Common in active adolescents during growth spurts. Presents as pain and bony swelling at the front of the shin, just below the knee. Load management, quadriceps stretching, and biomechanical assessment are the cornerstones of treatment.
Foot — Hypermobility
Hypermobility-Related Pain
All ages — more common in girls
Generalised joint hypermobility is common in children and can contribute to foot, ankle, and lower limb pain — particularly after activity. Hypermobile children often fatigue quickly, complain of aching legs in the evening, and may have a pronated flat foot posture. Strengthening and orthotic support can significantly reduce symptoms.
Foot — Forefoot
Iselin's Disease
Typical age: 8 – 13 years
Traction apophysitis at the base of the fifth metatarsal — where the peroneus brevis tendon attaches on the outer border of the foot. Often overlooked and mistaken for a sprain. Presents as pain and tenderness over the outer midfoot, worsened by running and lateral movements. Requires load management and footwear assessment.
Leg — Nocturnal
True Growing Pains
Typical age: 3 – 12 years
Bilateral, diffuse, non-articular leg pain occurring at night or in the evening — typically in the thighs, calves, or behind the knees. No swelling, redness, or limp. Resolves with massage and analgesics. Associated with activity levels, hypermobility, and low pain threshold. A diagnosis of exclusion — other causes must be ruled out first.
True Growing Pains
Self-limiting in the majority of cases. Resolves as children grow through adolescence. Reassurance, massage, stretching, and activity management are usually sufficient. Assessment is appropriate to exclude other causes.
Usually self-resolving
Sever's Disease
Resolves with skeletal maturity when the growth plate fuses — typically by age 15–16. Management is aimed at reducing pain and keeping the child active during the symptomatic period, which can last 1–2 years without intervention.
Self-limiting — manage symptoms
Paediatric Flat Feet
Physiological flat feet often resolve by age 6–8 as the arch develops. Symptomatic flat feet — with pain or gait changes — and rigid flat feet at any age require assessment and may benefit from orthotic or rehabilitation intervention.
Assess if symptomatic
Typical Presentations
Leg aching or throbbing at night or after activity
Bilateral leg pain — both sides affected
Heel pain at the back or underside — worsened by sport
Knee pain below the kneecap in an active adolescent
Foot fatigue or aching after school or sport
Outer midfoot tenderness — possible Iselin's disease
Flat feet with complaints of pain or fatigue
Reluctance to participate in sport or PE
Red Flags — Seek Prompt Assessment
These features should not be attributed to growing pains and require prompt clinical evaluation to exclude serious pathology:
Pain that is consistently unilateral (one side only)
Visible swelling, warmth, or redness over a joint
A limp — at any stage of the day
Pain severe enough to wake the child from sleep repeatedly
Morning stiffness lasting more than 30 minutes
Systemic symptoms — fever, weight loss, fatigue
Pain that is worsening rather than episodic
Neurological features — weakness, altered sensation
Growing pains are a diagnosis of exclusion. The following conditions can present with similar symptoms in children and must be considered before a benign label is applied — particularly if any red flag features are present.
Juvenile Idiopathic Arthritis (JIA)
Chronic inflammatory joint disease in children presenting with persistent joint pain, swelling, and morning stiffness lasting more than 6 weeks. Unlike growing pains, JIA pain is articular, may be associated with systemic features, and does not resolve with simple analgesics. Requires rheumatology assessment and is managed with disease-modifying therapy.
Legg-Calvé-Perthes Disease
Avascular necrosis of the femoral head in children aged 4–10. Presents with hip or groin pain, a limp, and restricted hip internal rotation. May be referred to the knee. Urgent imaging is required. A child with a persistent limp and hip or knee pain should not be attributed to growing pains without hip assessment.
Bone Tumours / Leukaemia
Rare but important. Bone pain in children that is constant, worsening, present at night unrelated to activity, or associated with systemic symptoms (pallor, fever, weight loss, unexplained bruising) must be investigated urgently. These presentations should never be dismissed as growing pains.
Tarsal Coalition
An abnormal bony or fibrous bar between tarsal bones — most commonly calcaneonavicular or talocalcaneal — that becomes symptomatic in adolescence as it ossifies. Presents with a rigid flat foot, restricted subtalar motion, and recurrent ankle sprains. Plain X-ray and CT are diagnostic. Often misinterpreted as flat foot pain or general foot aching.
Stress Fractures
Activity-related bone stress injuries are increasingly common in young athletes, particularly in the tibia, fibula, and metatarsals. Pain is focal, worsens with activity, and does not resolve with rest in the way that growing pains do. MRI is the gold standard. Should be considered in any young athlete with persistent localised limb pain.
Hypermobility Spectrum Disorder
Generalised joint hypermobility with associated musculoskeletal pain, fatigue, and recurrent joint problems. Often labelled as growing pains in childhood. Distinguishing features include widespread joint laxity, recurrent sprains, positional fatigue, and pain disproportionate to activity. Beighton scoring and a thorough history establish the diagnosis.
Our approach to childhood foot and leg pain is grounded in accurate diagnosis first. We will not apply a generic label, recommend unnecessary treatment, or reassure a parent without a thorough assessment. Where a condition is genuinely self-limiting and no treatment is needed, we will say so clearly and explain what to watch for. Where treatment is appropriate, it is tailored to the child's age, activity level, and the specific diagnosis.
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Comprehensive Paediatric Gait Assessment
A structured clinical examination covering foot posture, joint range of motion, lower limb alignment, muscle strength, and neurological screening. Observation of walking and (where appropriate) running using Onform video gait analysis to identify biomechanical factors contributing to pain. Review of footwear and activity history. Identification of red flag features requiring urgent referral.
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Accurate Diagnosis & Expectation Setting
For many children — particularly those with true growing pains or mild physiological flat feet — the most important intervention is a clear explanation of the diagnosis, the expected natural history, and specific features to watch for. We never recommend treatment for a self-limiting condition that does not warrant it. Reassuring a family with accurate, evidence-based information is itself a valuable clinical outcome.
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Load Management for Growth Plate Conditions
For Sever's disease, Osgood-Schlatter, and Iselin's disease, a structured activity modification plan is essential. We help families understand how to reduce load sufficiently to allow symptoms to settle — without enforcing complete rest, which is rarely necessary or beneficial. Return-to-sport timelines are built around pain response rather than arbitrary rest periods.
04
Stretching & Strengthening Programmes
Age-appropriate exercise programmes addressing calf tightness (Sever's), quadriceps flexibility (Osgood-Schlatter), intrinsic foot strength (flat feet, hypermobility), and hip and gluteal strength where proximal mechanics are contributing to lower limb loading. Exercises are demonstrated in clinic and provided as written take-home programmes with clear progressions.
05
Custom Orthotics & Insoles
Where there is a clear biomechanical rationale — symptomatic flatfoot, hypermobility contributing to fatigue and pain, or a growth plate condition aggravated by abnormal load distribution — orthotics can provide meaningful support. Off-the-shelf heel lifts are often effective for Sever's disease. Custom orthotics are prescribed when the clinical findings indicate they are necessary, not as a default response to childhood foot pain.
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Footwear Guidance
Well-fitting, supportive footwear with adequate heel cushioning and a flexible forefoot is important across most paediatric foot conditions. We advise on shoe selection appropriate to the child's foot type, age, and activity level — and flag footwear choices likely to aggravate symptoms, including flat plimsolls, slip-on shoes for children with flat feet, and minimalist trainers for children with growth plate conditions.
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Referral Where Indicated
Where red flag features are present, where the diagnosis is uncertain, or where conservative management has not produced adequate improvement, we refer promptly to the appropriate specialist — paediatric orthopaedics, rheumatology, physiotherapy, or for imaging. We maintain clear referral pathways and communicate directly with parents about the reason for any onward referral.
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We distinguish conditions from labelsWe do not accept "growing pains" as a final diagnosis without a thorough examination to exclude specific, treatable causes.
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Honest, evidence-based adviceWe will not recommend treatment for a self-limiting condition. Clear information about what to expect — and when to come back — is a core part of every assessment.
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Video gait analysis with OnformObjective measurement of lower limb mechanics and foot posture — with findings explained clearly to parents and tracked at follow-up.
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Age-appropriate treatmentExercise programmes, orthotics, and load management plans are tailored to the child's age, diagnosis, and sport or activity goals.
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Clear referral pathwaysWhere paediatric orthopaedics, rheumatology, or imaging is needed, we refer promptly and explain the reason clearly.
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HCPC-registered podiatristsRichmond (TW9) and Kensington (W8) — no GP referral required.
My child complains of leg pain at night — is this growing pains?
It may be. True growing pains are bilateral, occur in the evenings or at night, are not associated with swelling or a limp, and resolve with massage or simple analgesics. However, if the pain is consistently one-sided, is associated with swelling, redness, or limping, or wakes your child repeatedly and is not settling, it warrants assessment to exclude a specific cause. Growing pains is a diagnosis of exclusion — other conditions must be ruled out first.
My child has heel pain that gets worse during sport. What is causing it?
In an active child between 8 and 14 years of age, activity-related heel pain is most commonly Sever's disease — inflammation of the calcaneal growth plate at the Achilles tendon insertion. It is the most common cause of heel pain in this age group and responds well to calf stretching, heel lifts, and load management. A clinical assessment will confirm the diagnosis and rule out other causes including a stress fracture or retrocalcaneal bursitis.
Should I be worried about my child's flat feet?
A degree of flat foot is entirely normal in young children and typically resolves as the arch develops through early childhood. Assessment is appropriate if the flat feet are symptomatic — causing pain, fatigue, or gait changes — or if the feet appear rigid (the arch does not reappear on tip-toe), as this may indicate a structural cause such as tarsal coalition. Asymptomatic flexible flat feet in a child who is walking, running, and participating in sport without difficulty do not routinely require treatment.
Does my child need custom orthotics?
Not necessarily — and not as a first response to childhood foot pain. Orthotics are indicated when there is a specific biomechanical rationale identified in the assessment: a symptomatic flatfoot posture, hypermobility contributing to fatigue and joint pain, or a growth plate condition aggravated by abnormal loading. For many children with Sever's disease, a simple heel lift is sufficient. We will only recommend orthotics if the clinical findings clearly support them.
When should I take my child to see a podiatrist rather than waiting it out?
An assessment is appropriate if your child has been limping, if pain is preventing them from participating in sport or school, if symptoms have been present for more than 4–6 weeks without improvement, if the pain is consistently in one location rather than diffuse bilateral leg aching, or if you notice any swelling, redness, or warmth over a joint. You do not need a GP referral to book an appointment with us.
Is treatment covered by health insurance?
Yes — paediatric podiatry consultations are typically covered by most major insurers. We are recognised by BUPA, Aviva, WPA, AXA PPP, Vitality, Cigna, and Simply Health. See our
insurance page for full details.
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