Heel Pain in Children

By Dr. Carlo A. Messina

Does your son or daughter complain of heel pain daily, especially during or after activity? Do they remember any traumatic event or did the pain just occur? If this sounds like your child, there is a high probability that they have Calcaneal Apophysitis (or Sever’s Disease). This is actually a condition and not a disease. This occurs when the growth plate (apophysis) located at the bottom and back of the heel (the portion of the bone that allows growth) becomes painfully inflamed. Although plantar fasciitis (inflammation of the ligament that supports the arch) is the most common cause of heel pain in adults, it is extremely uncommon in children.

Cause

▸ Growth plate inflammation on the back and the bottom of the heel

▸ Over-activity in children commonly between the ages of 8 and 14

▸ Tight muscles in the lower extremity, especially the calf muscle

▸ Flatfeet

▸ Poor shoe gear or walking barefoot

▸ Growth spurts

SYMPTOMS

▸ Discomfort in the heel bone at the end of activity

▸ Occasionally painful to the Achilles and ankle

▸ Stiffness in the foot in the morning and pain with walking or running

▸ Pain alleviated by rest and a decrease in activity

SEVER'S DISEASE

▸ Pain is usually present during or after a child is done with the activity, sits for a period of time, and then tries to get up and walk

Signs

Tenderness to the back and bottom of the heel with touch or grasping the heel

▸ Walking on the ball of the foot to avoid touching the heel to the ground

▸ Discoloration and swelling are almost never seen in the heel

▸ Limping at the end of an activity that may persist as the condition worsens

Treatment

▸ Modification of activity and avoiding going barefoot

▸ Rest and ice

▸ Stretching exercises

▸ Proper shoe gear and heel lifts to decrease tension on the heel

▸ Night splinting to stretch the tight calf muscle and arch ligament

▸ Taping the foot to decrease the pulling of the plantar fascia on the heel bone

▸ Custom molded orthotics to support the foot and help restore proper alignment

▸ Occasional immobilization in a boot or cast to completely rest the heel and allow healing

▸ Physical therapy to improve flexibility and diminish inflammation of the growth plate

▸ Carlo A. Messina, DPM, is a Board Certified Reconstructive Foot and Ankle Surgeon, Diplomate American Board of Foot and Ankle Surgery. He is a Foot and Ankle Surgeon with the Foot, Ankle and Leg Specialists of South Florida and specializes in treating infants, children, teens and adults. The South Florida Institute of Sports Medicine in Weston is located at 1600 Town Center Blvd., Suite C, (954) 389-5900 and in Pembroke Pines at 17842 NW 2nd Street, (954) 430-9901. www.SouthFloridaSportsMedicine.com