Heel pain is common in children. While it can occur after a specific injury, it is also commonly caused by Sever’s disease, a type of overuse syndrome, like shin splints or Osgood-Schlatter?s disease. Children with Sever’s disease, which is also called calcaneal apophysitis, develop inflammation where the Achilles tendon inserts at the calcaneus, or heel bone. This inflammation causes pain, which can vary depending on the type of activity your child is doing, and is generally worse after activity(such as running and jumping) and improves with rest. Sometimes squeezing the heel can cause pain and occasionally it can be felt under the heel.
The foot is one of the first body parts to grow to full size. During the time of growth, bones grow faster than muscles and tendons. This results in the muscles and tendons becoming tight. The strongest tendon that attaches to the heel is the Achilles Tendon. It attaches to the back of the heel at the site of the growth plate, and during sports activities it pulls with great force on the growth plate. If this pull by the tight Achilles Tendon (calf muscle) continues for long periods of time, the growth plate may become inflamed and painful. If exertive activities continue, Sever’s Disease may result.
The symptoms include pain, tenderness, swelling or redness in the heel, and they might have difficulty walking or putting pressure on the heel. If you notice that your child suddenly starts walking around on their toes because their heels hurt, that?s a dead giveaway. Kids who play sports might also complain of foot pain after a game or practice. As they grow, the muscles and tendons will catch up and eventually the pressure will subside along with the pain. But in the meantime, it can become very uncomfortable.
A Podiatrist can easily evaluate your child?s foot, lower limbs and muscular flexibility, to identify if a problem exists. If a problem is identified, a simple treatment plan is put in place. Initial treatment may involve using temporary padding and strapping to control motion or to cushion the painful area and based on the success of this treatment, a long-term treatment plan will be put in place. This long-term treatment plan may or may not involve Foot Supports, Heel Raises, muscle stretching and or strengthening.
Non Surgical Treatment
The doctor might recommend that a child with Sever’s disease perform foot and leg exercises to stretch and strengthen the leg muscles and tendons, elevate and apply ice (wrapped in a towel, not applied directly to the skin) to the injured heel for 20 minutes two or three times per day, even on days when the pain is not that bad, to help reduce swelling, use an elastic wrap or compression stocking that is designed to help decrease pain and swelling, take an over-the-counter medicine to reduce pain and swelling, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Children should not be given aspirin for pain due to the risk of a very serious illness called Reye syndrome. In very severe cases, the doctor might recommend that the child wear a cast for anywhere from 2 to 12 weeks to immobilize the foot so that it can heal.
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.