Foot Pain at Night in Children: Growing Pains or a Reason to Worry?

It’s after bedtime. Everyone is tucked in and nearly asleep. 

Then, there’s a wail from a child’s room, “My foot hurts!”

Why would a child complain about foot pain at night? There are many possibilities. Today I’ll review a few of the most common reasons a child’s feet may hurt at night. 

Then, I’ll list a few reasons to seek prompt medical care. Even though most foot pain at night is nothing to worry about, there are a few times not to delay more investigation. 

Common causes of foot pain at night in kids

Below are some of the most common reasons a child may complain of their feet or lower limbs hurting after bedtime. Please remember this is not any kind of medical advice. I hope it’s a useful starting point for a parent trying to figure out what to focus on when checking in on their child. Please see your own pediatrician for specific guidance.

1. Growing Pains

Fun fact: There’s no firm evidence that so-called growing pains are literally from a child growing too quickly. Even the fastest growth spurts won’t be fast enough to be uncomfortable. 

However, young kids do get aches in their muscles at night, and we may still refer to them as “growing pains.” It’s an uncomfortable and sore pain, and yes, some kids cry with it. Usually worse in the lower legs, it can affect children’s feet too. 

Pain may be due to growing pains if:

•  The pain changes location from one night to the next. Its not always on one side in one spot.
•  The skin, leg, and foot look completely normal. 
• There’s no rash or swelling. 
• There are no bumps or lumps. 
• The pain is in the muscles, not the bones or joints. Calf muscles are one of the most common places to have growing pains. 

Sometimes growing pains are more likely after a really busy and active day. And, while growing pains may make falling asleep a bit tricky, they rarely wake a child up from a sound sleep.

Growing pains do not cause a fever. 

What helps soothe growing pains?

After diagnosis, a pediatrician may recommend gentle massage for the sore leg muscles. They might also suggest over-the-counter pain relievers like acetaminophen or ibuprofen. Some children find relief using a heating pad for a few minutes. (They should not fall asleep with a heating pad for safety reasons). Kids should also stay hydrated and rest when needed during the day. 

2. Injury

An actual injury to the muscle or bone can also be painful later in the day. The source of pain may be obvious when asking a child.

In some cases, it may not be so obvious. It’s not always a foot injury!

So, I always remind parents to also ask about ankles, knees, and hips if a child complains of foot pain. A knee injury could also cause pain in the feet, for example. Everything is connected, right? And, our bodies will try to compensate. In this example, a knee injury can lead to limping. The limping can mean each step is different than normal. These slightly different steps can result in foot pain. 

Then, the specific injury can be addressed! It’s easier to address it once we know it exists. 

What helps a lower limb injury?

If it seems like a sprain, twisted ankle, or sore muscle from something earlier in the day, an ice pack or cool compress can help with swelling. Keeping the injured area elevated is a good idea.

If there is any concern about blood flow, please call your child’s doctor or go to the emergency room (ER). Some signs include the toes looking discolored or feeling colder than normal. Or, if a child isn’t able to move part of their leg or foot (like wiggling toes), seek immediate care.

3. Sever’s Disease

This is one type of “injury.” It’s also called calcaneal apophysitis and its a really common cause of heel pain. Kids who have this usually complain of heel pain with physical activity, especially activities like running on hard surfaces. I think of basketball players. However, the pain can last and kids may complain of heel pain after the activity too. They usually point to just above the heel bone, near the back of their foot. 

The pain comes from inflammation of the growth plate where the Achilles tendon attaches to the back of the heel.

Although it’s more common in active children, it’s possible in kids who are not as physically active. 

What can be done about Sever’s Disease?

A child’s physician can examine the foot and make specific recommendations to help relieve the pain. Sometimes the treatment options include things like rest, shoe inserts, ice, or pain relievers like NSAIDS (non-steroidal anti-inflammatory medications like ibuprofen). 

Thankfully, most kids outgrow Sever’s Disease.

4. Skin problems in the feet

This may seem obvious, but if a child complains of foot pain, it’s worth looking at it the skin. Sometimes the skin will quickly reveal what’s going on. Some examples are:

Sunburned feet

Too much time in the sun can cause the skin to be very uncomfortable! Sometimes we forget about sun protection for kids‘ feet. 

If this is the case, cool wet towels (cold compresses) can help calm a child’s pain.  If there are blisters due to sunburn, please call your child’s doctor.

Warts

Plantar warts are on the sole of the feet. And even though they’re harmless, they can be uncomfortable, especially if something is touching or pushing on them. A parent may not even know their child has a wart until there’s a complaint.

For acute treatment, a cold pack can help. In other words, if your child is up at night complaining of wart pain, taking off tight socks and applying an ice pack is a good start.

For long term treatment, there are effective over the counter options. And, this is a common reason to see the pediatrician. They can help with this too in the office. 

Ingrown toenail 

This happens when the toenail (usual the big toe) grows into the surrounding skin. The skin often appears more pink. Sometimes there’s some swelling. Even the slightest touch can be excruciating.

If a child can’t sleep due to an ingrown toenail, one of the first steps is to free the toe. Take off socks or slippers or footie pajamas. 

Warm or cool compresses can also help a child enough to get some sleep. 

To prevent ingrown nails; trim nails straight across. A curve can make it more likely for the nail to grow into the skin. Make sure kids’ shoes are not too tight. Any kind of rubbing against the toe or nail can make ingrown toenails more uncomfortable. 

If the swelling doesn’t go down or if there is any pus drainage, it may also be infected. Seeking prompt medical care is a good idea. 

Bug bite on the feet

It’s funny how something that happens hours before bedtime doesn’t seem like a big deal until it’s time to sleep. This is why peeking at the place a foot hurts helps a lot. If your child is old enough, ask them to point “with one finger” where the pain is the worst. If they point to a bug bite or mosquito bite, you’ve got an answer. 

Yes, even a bug bite can cause foot pain at night.

We usually think of them as itchy. However, they can hurt too. And, many really young children may not be able to describe “itchy,” but they can say “ow.”

A quick note on “spider bites.” Unless you have actually seen a spider crawl up and bite your child’s foot, there’s a chance they don’t have a spider bite. Some skin infections (see below) start off as a small bump or pustule that many people refer to as a “spider bite.” Keep an eye on these and consider the information below under “skin infection.”

In this case too, a small ice pack may be all that’s needed. A dab of over-the-counter (OTC) hydrocortisone ointment can help with the itch too. If no hydrocortisone is available, allowing the child to dab something harmless, like Vaseline, can also distract from the itch and may even help soothe.

Lastly, double check that fingernails are well-trimmed. This can help prevent a child scratching themselves and causing another issue. 

Skin infection

Signs of a skin infection (also known as cellulitis) include redness, tenderness, pus drainage, and/or warmth to the area. These are all good reasons to seek medical care. Many of these infections are caused by bacteria. Sometimes, they need treatment, so it’s best for kids with a possible skin infection in to be seen by a health care professional. 

Something done in the ER, urgent care, or pediatrician’s office can also be started at home. Mark the area with a pen or marker and write the time. This way, if it gets bigger, you’ll know how much and how fast it spreads. You can also take a photo near an object for scale. A ruler is one option, but even a coin or other standard -sized object works too. 

In the meantime, a warm compress can help with any drainage. Keep the foot or leg elevated. And, acetaminophen or ibuprofen is reasonable. Again, skin infections warrant a doctor’s visit. Wondering what other skin conditions need medical attention? See this post.

Reasons to Seek Medical Care for Foot Pain in Kids

Most of the reasons above are not emergencies. (The huge exception is an infection which can vary a lot). However, there are some times when families should see their doctor. If a child has any of the following symptoms, please call your child’s pediatrician. In these cases, they may want to perform a physical examination and may consider blood tests or imaging (like x-rays). 

• Ongoing fevers at night (As a reminder: fever is more than 100.4°F)
• Painless swelling or a bump that doesn’t go away or just gets bigger. This warrants a thorough evaluation.
• Pain actually wakes the child from sleep.
• A child can’t bear weight due to leg pain or foot pain.
• Other symptoms like unintentional weight loss. (If a child’s symptoms include a rash or fever, take a look at these linked posts for more detail). 
• Any severe pain (day or night), needs to be checked out. If it’s slowing a child down, or otherwise bothersome, it’s worth investigating. 

Summary: Foot problems for children at night can vary from harmless to more serious.

A child’s foot pain at night can be due to injury, growing pains, skin issues, knee or ankle pain, other leg problems, and rarely something more serious.

We can start by asking the child exactly where their pain is and not forget to check out the entire lower limb, including ankle, knee, and hip.

And yes, common causes of foot pain in adults (bunions, plantar fasciitis, etc) can happen in kids, but just not as often.

If there’s not a clear explanation for your child’s foot problems or your child is bothered by it, please see their doctor. 

Maya M. Mahmood, D.O., FAAP is a board-certified pediatrician and mom. She is passionate about parents having evidence-based information to help their families be healthier.

Disclaimer:

This is for information only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.