Why do my children have heel pain?
This time of year with winter sports underway, this is one of the most common questions parents ask us. Heel pain, caused by calcaneal apophysitis (also called Sever’s disease) is common in physically active children. The condition can be very painful but is only temporary and has no long-term effects. Children will describe pain at the back of the heel where the growth plate has not yet fully developed and calcified. It usually occurs in the period in early adolescence when children grow most rapidly. This growth spurt can begin any time, approximately between the ages of 9-12 in girls and 10-12 in boys. A large tendon, called the Achilles Tendon, joins the calf muscle at the back of the leg, to the heel. Sever’s disease is thought to occur because of a mismatch in growth of the heel bones to the calf muscle and Achilles Tendon. If the bones grow faster than the muscles, the Achilles Tendon that attaches the muscle to the heel gets tight. At the same time, until the cartilage of the calcaneum is ossified (turned into bone), it is a potential weak spot. The tight calf muscle and Achilles Tendon cause a traction injury on this weak spot, resulting in inflammation and pain. Such stresses result from sports or activities that require a lot of running, jumping and landing, especially on hard surfaces. Examples would include football, netball and track running. The immediate goal of physiotherapy treatment is pain relief. The symptoms will generally worsen during or after activity; so the most important aspect of treatment initially is rest or activity modification.