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Pediatric Heel Pain

Posted Oct 13 2010 12:00am 1 Comment
What is pediatric heel pain?  Heel pain is a very common childhood complaint.  This doesn't mean that it should be ignored.  Heel pain is a symptom, not a disease.  This means that the pain is a warning sign that your child has a condition that deserves attention.  The most common cause of pediatric heel pain is a disorder called calcaneal aphpysitis, and usually affects 8 to 14 year olds.  However, pediatric heel pain can be a sign of many other problems and can occur at younger or older ages.
Pediatric heel pain is very different than adult heel pain.  With adult heel pain, the pain is intense when getting out of bed in the mornings or after sitting for long periods of time.  The pain subsides after walking around a bit.  In pediatric heel pain, the pain usually doesn't improve in the same manner, it usually becomes worse with walking around.    Heel pain is common in children because of the very nature of their growing feet.  Because their feet are continually growing, the heel bone (the calcaneus) is not fully developed until the age of 14 or older.  Until the heel bone is developed, new bone is forming at the growth plate (the physis).  This is a weak area located at the back of the heel.  Too much stress on the growth plate is the most common cause of pediatric heel pain.

Symptoms of pediatric heel pain include
  • Pain in the back or bottom of the heel
  • Limping
  • Walking on toes
  • Difficulty participating in usual activities or sports
If your child has any of these symptoms, you should see a podiatric specialist to determine the underlying cause of the pain to determine a plan of treatment.  There are a number of possible causes for a child's heel pain.  Some of these causes may include:
  • Calcaneal apophysitis.  More commonly known as Sever's disease, this is the most common cause of children's heel pain.  This is not a true "disease", it is an inflammation of the heel's growth plate due to muscle strain and repetitive stress. This especially occurs in children who are active or obese.  This condition usually causes pain and tenderness in the back and bottom of the heel when walking and is painful when touched.  This condition can occur in one or both feet.
  • Tendo-Achilles bursitis.  This condition is an inflammation of the fluid-filled sac (bursa) located between the Achilles tendon and the heel bone.  Tendo-Achilles bursitis can result from injuries to the heel, certain diseases like juvenile rheumatoid arthritis or wearing poorly cushioned shoes.
  • Overuse syndromes.  The heel's growth plate is sensitive to repeated running and pounding on hard surfaces.  Because of this, pediatric heel pain often reflects overuse.  Children and adolescents are especially vulnerable if they are involved in soccer, track or basketball.  A common overuse syndrome is Achilles tendonitis.  This inflammation of the tendon usually occurs in children over the age of 14.  Another common overuse syndrome is plantar fasciitis.  This is an inflammation of the band of tissue (the plantar fascia) that runs along the bottom of the foot from heel to toes.
  • Fractures.  Heel pain is sometimes caused by a break in the bones.  Stress fractures(hairline breaks resulting from repeated stress on the bone) often occur in adolescents engaged in athletics, especially when the intensity of training suddenly changes.  In children under the age of 10 acute fractures can simply result from jumping 2 or 3 feet from a couch or stairway.
Arch Angel Childrens Comfort Insoles
Treatment depends on the diagnosis and the severity of pain.  For mild heel pain, some treatment options may include to reduce or stop any activity that may be causing the pain.  You might want to try an insole like Arch Angel Childrens Comfort Insoles  that will help cushion the heel when walking, running, and standing.  Your doctor may also have your child take a non steroidal anti-inflammatory drug like ibuprofen to help reduce the pain and inflammation.  Physical therapy and stretching exercises are sometimes used to promote healing of the inflamed tissue.  Your doctor may also recommend getting custom molded orthotics to support the foot properly.

You can also reduce your chances of developing heel pain by avoiding obesity, choosing well-constructed and supportive shoes that are designed appropriately for your child's activity.  Also avoid or limit the wear of cleated athletic shoes as well as avoiding activity that is beyond your child's ability.

If your child has any of the symptoms listed above or concerned about your child's foot health, please contact our office at 419-423-1888 to schedule an appointment with Dr. Vail or visit our website at .
Comments (1)
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By far, Sever's disease or calcaneal apophysitis is the most common cause of heel pain that I see in the office.  Rest is the best therapy since this is a self limiting condition, but it is very difficult to get the child to stay off the foot.

I find that strapping the heel tends to give the most relief.

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