Heel Pain: The Agony of De-Feet

Does your child complain of heel pain with or without a reported injury? Does the pain seem worse after activities or sports play? Are they walking around the house with a limp? Kids that are going through rapid growth, while being active in sports and other activities, can experience heel pain due to overuse. This condition is known as Calcaneal Apophysitis or Sever’s Disease.

 

What is Calcaneal Apophysitis?

 

The heel bone is called the calcaneus. In children, there is an area on the heel bone where the bone grows that is called the growth plate, or apophysis. Calcaneal Apophysitis, also called Sever’s disease (not a disease but a condition), is inflammation of the calcaneal growth plate that causes pain in the heel. It is the most common cause of heel pain in children, adolescents, and teenagers. This condition is temporary and typically has no long-term effects. 

 

The inflammation at the growth plate is caused by overuse activities that cause repetitive heel strikes. This typically occurs with high impact athletes that consistently run, jump, cut and land. Also this pain can be associated with cleated athletes or athletes that are required to wear shoes with poor heel padding or 

poor arch support.

It usually occurs during the growth spurt of adolescence, th

e approximately 2-year period in early puberty when kids grow most rapidly. This growth spurt can begin any time between the ages of 8 and 13 for girls and 10 and 15 for boys. Sever’s Disease rarely occurs in older teens because the back of the heel usually finishes growing by the age of 15, when the growth plate hardens and the growing bones fuse together into mature bone.

 

Symptoms

 

Typically a child will complain of heel pain with run, cut and jump activities. There may be swelling and redness at the heel. These symptoms will increase with activity and tend to decrease with rest. There may be some associated Achilles Tendon pain. A painful limp may also be associated with this condition. Some kids complain of pain first thing in the morning with their first steps out of bed.

 

Diagnosis

 

This condition is diagnosed clinically through a good medical history and physical exam.  The child may have a positive squeeze test, squeezing the back of the heel from both sides causing pain. An x-ray of the heel may be needed to rule out other causes of pain, including fracture, stress fracture, boney growth/cyst and other causes of bone pain.

 

Treatment

 

The treatment suggestions for this condition are quite simple and straight forward. With that being said each aspect of the treatment plan can be compared to a piece to the puzzle and it may take trial and error to arrange these pieces properly. Outlined below are the suggested treatment options:

 

  • Rest from high impact activities
  • Physical Therapy stretching techniques for the Achilles Tendon
  • Anti-inflammatory medications: Ibuprofen (Motrin/Advil) or Naproxen Sodium (Aleve)
  • Application of ice to the heel
  • Good supportive athletic shoes: Shoes with a stiff sole and visible arch support
  • Limit of overuse activities
  • Casting or Immobilization (Boot) : Reserved for more severe cases

 

There are many causes of “Agony of De-Feet” and we have only discussed the most common in children.  These other causes include: stress fractures, boney cysts, boney malformations, soft tissue injuries, etc.  To insure your child has been properly diagnosed and following the appropriate treatment plan, we recommend a consultation for the quickest recovery and best outcome.