Heel Pain in Children

Children may experience heel pain similarly to adults; however, the reasoning for an adult’s heel pain is most commonly plantar fasciitis, whereas with children, the cause may be due to Sever’s Disease. Sever’s Disease is also known as calcaneal apophysitis. The calcaneus is the heel bone and apophysitis is the term for inflammation of the heel bone’s growth plate. Girls who have Sever’s Disease are usually between the ages of 8-13 years old and boys 10-15 years old. Since Sever’s Disease is due to the growth plate of the heel bone being inflamed and irritated, it is very rare for an adult to experience Sever’s Disease, since the heel bone growth plate fuses usually by 15 years of age.
What causes the growth plate of the heel bone to become irritated?
During a child’s growth period the ligaments and muscles may tug on the heel bone’s growth plate due to not growing as quickly as the heel, which this pulling will cause the growth plate to become inflamed. Specifically, stress on the Achilles tendon may cause severe irritation because the Achilles tendon attaches to the back of the heel.
Children who are at greater risk for Sever’s Disease include:
• Gymnasts, track and field athletes, and basketball players (usually athlete’s who play their sports on hard surfaces)
• Standing for long periods of time without having time to sit
• Poor fitting shoes and shoes that lack adequate heel padding
• Children who excessively pronate, which is the inwards tilting of the foot
The symptoms of Sever’s Disease include:
• Pain in the back and occasionally the sides of the heel bone
• Pain with activity, even as severe as causing limping
• Stiffness of the feet when first getting out of bed
• Pain that is the worst with activity, but is relieved with rest
• Swollen heel
• Red heel
Sever’s Disease does not have any long-term effects, but the pain can be severe, so it is important to seek treatment. There are numerous treatment modalities for Sever’s Disease and it is important that you have your child’s heel pain examined. The Boulder County Foot and Ankle or Platte Valley Foot and Ankle Clinic will evaluate your child’s pain and take an x-ray of their foot. Sever’s Disease is usually diagnosed clinically based off symptoms and age. However, an x-ray will show if the growth plate is still open. Do not be alarmed when you see the x-ray as an open heel bone growth plate appears like a very jagged heel fracture; however, this appearance is completely normal.
Once your child is diagnosed for Sever’s Disease, the treatment is rather simple and surgery is not required. Treatment includes:
• Taking time off from sports and activity-usually 4-8 weeks
• Icing the heel will be beneficial in order to get rid of the inflammation in the area, which will also help relieve pain
• Your child may be prescribed anti-inflammatory medications (Never give your child Aspirin, as this may lead to Reye’s Syndrome, which is life threatening)
• Your child may be prescribed a walking boot or surgical shoe, which will prevent the irritating motion and pulling at the heel bone’s growth plate, which will help to relieve pain
• A heel cup may also be prescribed, which your child will be able to slip into his or her shoes
• Physical therapy to help stretch and strengthen your child’s muscle, which can relieve pain
• Custom orthoses to attempt to fix any biomechanical abnormalities, such as pronation
Your child should see decrease in their symptoms within one month of beginning treatment, so do not ignore your child’s heel pain complaints as there are easy treatments available to help rid the pain and allow them to enjoy their summer to the fullest.

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