Pediatric Heel pain refers to a sign/symptom that a child’s foot or feet require medical attention. Foot problems amongst children who are experiencing heel pain may also have difficulty with regular physical activities such as sports, and may begin to limp and/or walk on their toes.
Research shows that this heel pain most commonly results from a child experiencing calcaneal apophysitis, a disorder which normally affects those 8-14 year of age (see below). However, this pain may also signify other conditions, and can affect children younger than 8 as well as teens.
Since heel pain diagnosis can be a challenge, it is in the child’s best interest to consult a podiatrist, as they can best determine the cause and recommend a treatment plan that is most effective for your child’s condition.
Possible causes include:
- Calcaneal Apophysitis (Sever’s Disease): Although not an actual disease, it is a painful condition and very common among children. It describes a condition in which a child’s heel growth plate becomes inflamed causing the heel to be tender even when touched. Brought on by continuous strain to the muscles and repeated stress, it is especially common in those with active lifestyles or who are obese, and can affect both feet.
- Fractures: Fine breaks in the bone may occur after repeat stress is applied to the feet. Acute fractures, affecting children under the age of 10, can result from a child simply jumping off of furniture. Stress fractures on the other hand, affect adolescents and are hairline breaks caused by repeat stress applied to the bone. This is most common among young athletics, especially when training intensity suddenly increases.
- Overuse syndromes: Refers to the increased sensitivity of the child’s heel growth plate when a child excessively runs or jumps and lands on a hard surface. Children vulnerable to overuse are normally those who run track or play soccer or basketball. Achilles tendonitis is a syndrome that is common and usually affects children over 14 and involves a tendon inflammation. Another common syndrome is one which actually affects adults most often, Plantar Fasciitis. This condition describes when the line of tissue that stretches across the bottom of a person’s foot from heel to toes (also known as plantar fascia) becomes inflamed.
- Tendo-Achilles Bursitis: Refers to an inflammation of the bursa, or fluid-filled sac located between the Achilles tendon and heel bone. Those affected by develop this after suffering from heel injuries, diseases such as juvenile rheumatoid arthritis, or wearing shoes that aren’t cushioned properly.
After obtaining an extensive medical history report and discussing the child’s recent activities, your podiatric surgeon will perform an examination of the foot/leg. Bone scans, X-rays, an MRI study, or CT/CAT (computerized tomography scan) are commonly used in order to evaluate a child’s condition.
Ways to reduce your child’s chances of acquiring heel pain include:
- Avoiding over-activity that may be beyond the child’s abilities
- Avoiding or limiting wear of athletic cleats
- Avoiding childhood obesity
- Choosing supportive, well-made shoes, appropriate for the child’s specific activities
Differences in Pediatric and Adult Heel Pain
Heel pain affects so many children simply because of the process by which their feet grow. For example, a child’s heel bone, or calcaneus, does not fully develop until the age of 14 or older. In the meantime, new bone is forming at the growth plate, or the apophysis, located at the back of the heel. Too much stress on this weak plate is normally the cause of heel pain.
Heel pain experienced by children and that affecting adults differs in the way pain occurs. Plantar fascia pain, the most common heel pain affecting adults, is most intense in the morning when an adult gets out of bed and after sitting for long periods. Adults will notice that the pain somewhat subsides after walking around. In comparison, Pediatric Heel Pain normally doesn’t improve after walking around. In fact, it actually intensifies the pain.
Options for Treatment
For mild pain, options for treatment normally include:
- Cushioning the heel: Using shoe inserts help to soften the impact that daily activities place on a person’s heel.
- Reducing activity: Making sure the child stops the physical activity he/she is doing as soon as pain is experienced.
For moderate pain, some of the following treatment options may be recommended along with the 2 listed above:
- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may be prescribed to reduce pain/inflammation.
- Orthotic devices: Custom orthotic devices help offer support to the foot while healing.
- Physical therapy: Forms of physical therapy including stretching exercises are recommended to promote inflamed tissue healing.
Severe pain treatment may include:
- Immobilization: Crutches are necessary in some cases to avoid applying weight/pressure to the foot. In more severe cases, a cast may be worn to keep the foot/ankle completely immobile so that proper healing can take place.
- Follow-up care: If measures are required after immobilization, orthotic devices, strapping or physical therapy may be recommended.
- Surgery: In some cases when immobilization doesn’t correct the problem, surgery could be needed in order to completely correct the problem such as lengthening the tendon.
Pediatric Heel Pain often returns after being treated since the child’s heel bone continues to grow until the age of 14 or older. However, if your child’s heel pain returns, it is advised to consult your podiatric surgeon as recurrence may signify a different problem than what was diagnosed initially.