Click here for Heel Pain in Adults
Heel pain is one of the more common foot complaints in children. When
children get heel pain, the most common cause is a disturbance to the
growth plate at the back of the heel bone (calcaneus) where the strong
Achilles tendon attaches to it. This is known as Sever's disease
or calcaneal apophysitis (inflammation of the growth plate).
Apophysitis is most common between the ages of 10 to 14 years of age.
This is one of several different growth plate conditions that can occur
in the body, such as at the knee (Osgood-Schlatters Disease).
Heel pain in children is one of our specialties at our
Seattle Foot and Ankle clinic
and we can usually treat your child in a manner that will relieve their
pain quickly and help prevent the problem from returning. When treating
kids with heel pain our first goal is to confirm the correct diagnosis
and then institute a treatment plan to get them back to activity as soon
as possible.
Treatment
Evaluation of a child’s heel pain by a health professional is often
wise. Beside calcaneal apophysitis there are a few very rare problems
that may be causing the pain, so a correct diagnosis is important. Once
we confirm that the problem is due to calcaneal apophysitis our first
goal is to reduce tension on the tendons and ligaments that pull on the
growth plate. We usually do this with a prefabricated arch support or a
custom orthotic. To keep costs down, we often start with a prefabricated
orthotic and modify it to provide the best result for your child. If
this doesn’t provide adequate relief, then we will consider a custom
orthotic. Custom orthotics work better because, if they are made
correctly, they conform tighter to the arch of the foot and thus
transfer more pressure off of the heel. These are called
total contact orthotics.
Once we get the force off of the heel, then we start your child on a
program to get rid of the swelling and pain. This may include icing,
stretching, medication, activity modification and/or physical therapy.
In rare cases we need to use a removable walking cast for a couple of
weeks.
We’ll also work with you and your child to make sure they have the
appropriate shoes for their activities. Our goal is not only to cure the
current problem, but also to prevent it from returning.
Dr. Huppin and Dr. Hale are Seattle’s specialists in children’s heel
pain. You can make an appointment to see
us here.
The anatomy of Calcaneal Apophysitis
When a baby is born, most of the bones are still cartilage with only
some starting to develop into bone. When the heel (calcaneus) starts to
develop bone, there is generally one large area of development that
starts in the center of the cartilage heel. This area of bone spreads to
'fill up' the cartilage. Another area of bone development (ossification)
occurs at the back of the heel bone - see the xray to the right. These
two areas of developing bone will have an area of cartilage between them
- this is how the bone grows in size. At around age 16, when growth is
nearly complete, these two bony areas fuse together. Calcaneal
apophysitis is usually considered to be due to damage or a disturbance
in this area of growth
Symptoms of Calcaneaal Apophysitis
Pain is usually felt at the back and side of the heel bone. Sometimes
there may be pain at the bottom of the heel. The pain is usually
relieved when the child is not active and becomes painful with sport.
Squeezing the sides of the heel bone is often painful. Running and
jumping make the symptoms worse. One or both heels can be affected. In
more severe cases, the child may be limping.
Causes of Heel Pain in Children
The cause of calcaneal apophysitis is not entirely clear. It is likely
due to repeated minor trauma that happens in a lot of sporting
activities - the cartilage join between the two parts of the bone can
not take all the stress of the activities. Some children seem to be more
prone to apophysitis for unknown reasons - combine this with sport,
especially if it is on a hard surface and the risk of developing
apophysitis increases. Children who are heavier are also at greater risk
for developing calcaneal apophysitis. A tight calf muscle is also common
in those who develop calcaneal apophysitis. If you look at the picture,
you can imagine how much pull there is from the calf muscles via the
Achilles tendon on the small growth plate at the back of the heel. The
strain that this will place on the growth plate is significant
A pronated foot (a foot rolled in at the ankle) has also been
shown to make calcaneal apophysitis more likely. It is assumed that this
may cause an uneven weight bearing on the back part of the heel bone
Long Term Consequences
This condition is self limiting - it will go away when the two parts of
bony growth join together – this is natural. Unfortunately, it can be
very painful and limit sport activity of the child while waiting for it
to go away, so treatment is often advised to help relieve it. In very
rare cases of calcaneal apophysitis, the treatment is not successful and
these children will be restricted in their activity levels until the two
growth areas join - usually around the age of 16 years. There are no
known long term complications associated with Sever's disease.
Don’t let your child live with heel pain. It usually responds well to conservative treatment. Call today for an evaluation in our convenient Seattle office.
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Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
The material provided on this web site is for informative purposes only.
If you need specific medical advice, please contact the office for an appointment.
