The most common cause of pediatric heel pain is a disorder known as Sever’s Disease. This is not a disease but when named over a hundred years ago this is what it became known as. To make it even harder to remember its medical diagnosis is calcaneal apophysitis. This is an inflamed growth plate in the heel (calcaneus) bone. It usually occurs between ages 8 to 14.
If your child complains of heel pain, especially after sports, it shouldn’t be ignored. Your child may complain of pain on the bottom or back of the heel. Some children don’t complain but as a parent you may notice them walking on their toes, limping or having a difficult time running.
Adult heel pain differs from pediatric heel pain. Most adults get something called plantar fasciitis. This is pain on the bottom of the foot and occurs after long rest periods. The pain is intense but tends to lessen with use but recurs after rest.
Pediatric heel pain is the reverse. The more active the child, the more pain is encountered. In children, the bones are growing in 2 ways. First, they grow at what are called epiphysis, the bone grows in length. Second, they grow at the apophysis; the bone adds girth for strength. These are areas of bone that protrude out. For instance, below the knee and the outer hip have bony bumps. These are areas where tendons attach. In the back the heel, the Achilles tendon attaches and during growth the tendon is pulling while the bone is growing. With excessive activity the area of bone gets inflamed and is called apophysitis. Until the bone matures around age 14 the area is a weak spot.
There are other causes of pediatric heel pain and because of the challenge it is best to bring your child to a foot and ankle specialist for an evaluation. Besides Sever’s disease, one can develop Tendo- Achilles bursitis. This pain usually also has swelling behind the heel and could be a sign of juvenile rheumatoid arthritis. One can develop a stress fracture; which are hairline fractures within a bone due to too much intensity to an otherwise normal bone. And finally overuse syndromes which include tendonitis and mild sprains.
In today’s rapid pace of trying to make every child a professional athlete professionals are seeing more and more children limping into the office. It is rare, unfortunately, that after explaining the condition to the parents, the parents want their child to rest and heal. Instead they want a quick fix so their child can get back out onto the field or court. Dr. Chieppa discussed Pediatric Sports Injuries in depth in this 2 part series.
To get a diagnosis, the doctor will get appropriate test including x-rays and possibly MRI or CAT scan. In most cases a good evaluation is the only test needed to make the correct diagnosis.
There are a few ways to prevent heel pain. These include avoiding obesity, choose well-constructed supportive shoes, limit or avoid cleats, if possible and most important avoid pushing your child into too many activities.
Treatment for heel pain include reducing activity, cushions in the shoe and for more intense pain ice the area and use anti-inflammatory medications. Some patients require physical therapy or casting with crutches. When a patient has other foot abnormalities like flat feet or high arch feet, we make custom orthotics for the sports shoes to help stabilize the foot and decrease excess motion.
If your child is complaining of foot pain and not playing a sport to his known potential then make a visit to your foot and ankle specialist.
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