Patient Education

Pediatric Heel Pain

Description

Kids have it pretty rough. You may believe they have next to nothing to worry about, having no jobs, playing all day, living in some idyllic wonderland, but kids lives are often as complicated and stressful as adults’, just in different ways.

Take adolescence, for instance. Middle school and junior high were pretty much universally painful unless (or perhaps even if) you were one of the few on the top tier of the popularity totem pole. Remember how you had to deal with puberty, (possibly the most confusing and vexing period in any given human life), the whims and caprices of your school teachers, crazily fluctuating hormones, acne, and, on top of it all, your bones were still trying to grow to fit that adult body you weren’t quite ready for.

When you’re born, much of your skeletal structure is made up of cartilage rather than bone. As you grow older, your bones calcify, eventually turning into those hard, mineralized structures we know so well. (And it’s probably also why your mom keeps making you drink milk when you’re young.) The heel bone (calcaneus) is no exception. In this bone, calcification begins at two different spots, one near the center of the bone, and one at the rear of the bone. Where these two areas of bone development meet, there remains a thin band of cartilage known as a growth plate, or physis. It allows the calcaneus to continue growing until about age 16, when the two areas of bone development finally fuse together.

Occasionally in children ages 8 to 14, particularly in children who put a great deal of stress on the heel bone (usually in sports like basketball, soccer, or running), this growth plate can become inflamed, causing significant pain in the heel. Wearing shoes with cleats, having tight calf muscles, or being obese can also lead to or aggravate this condition. Inflammation of this growth plate is known as calcaneal apophysitis, if you’re into those medical terms, or is also referred to as Sever’s disease.

Symptoms

Pain in the heel from calcaneal apophysitis often develops quickly, and may occur in one or both feet. (When it occurs in three feet, you probably have more trouble than just an inflamed growth plate.) This pain may show up in the back of the heel, to the side, or on the bottom, and squeezing the sides of the heel is likely to cause pain. Your child may limp, walk on his or her toes, or have trouble participating in sporting activities. Resting the affected foot (or feet) usually offers some relief, but the pain will show up again when the child resumes activity.

Diagnosis

Because you’re a great parent, you’ll take your child in to see a podiatrist as soon as he or she starts having symptoms of foot pain. Once there, the podiatrist will probably ask you and your child about activities the child has been participating in. You’ll likely also need to provide a medical history. The podiatrist will perform a physical examination of your child’s foot and leg, and may use X-rays or other imaging technology to get a look at what’s happening with those growing bones.

Treatment

Treating inflammation of the calcaneal growth plate usually involves reducing the inflammation itself, and also attempting to minimize stress on the area. First of all, your child will likely need to take a break from the types of activities that can stress out the growth plate. (You may need to let those dreams of your 10-year-old Beckham go for a little while, until your child recovers.) Taking anti-inflammatory medication such as ibuprofen can help, as can applying ice to the heel (20 minutes on over a thin towel, 40 minutes off). Your podiatrist may also recommend immobilizing your child’s foot by putting it in a cast (usually for about 2 to 6 weeks), but this is usually reserved for more severe cases.

Your podiatrist might also suggest orthotics, which are prescription shoe inserts that can support your child’s individual foot shape. Or, your child may also find stretching exercises beneficial; they work to diminish tightness in the calf muscle and Achilles tendon, thus reducing the pull on the back of the heel and the consequent stress on the growth plate.

Even after treatment, your child’s heel pain may not be fully resolved, or may recur because the heel bone continues to grow. (Childhood really is tough, isn’t it?) Fortunately, once the bone is fully fused together (again, about age 16), this problem goes away, never to return. In a few cases, children may simply need to have reduced activity until their bones are fully developed. The good news is that, like many growing pains, this particular problem doesn’t cause any more complications once the child is fully mature.