Pediatric Heel Pain
What is pediatric heel pain?Heel pain
is a common childhood complaint. That
doesn’t mean, however, that it should
be ignored, or that parents should wait
to see if it will “go away.”
Heel pain is a symptom, not a disease. In other words, heel pain is
a warning sign that a child has a condition that deserves attention.
The most common cause of pediatric heel pain is a disorder called
calcaneal apophysitis, which usually affects 8 to 14 year olds.
However, pediatric heel pain may be the sign of many other
problems and can occur at younger or older ages. |
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Symptoms
Heel pain problems in children are often associated with
these signs and symptoms:
- Pain in the back or bottom of the heel
- Limping
- Walking on toes
- Difficulty participating in usual activities or sports
Pediatric Heel Pain vs. Adult Heel Pain
Pediatric heel pain differs from the most common form of heel
pain experienced by adults (plantar fasciitis) in the way pain
occurs. Plantar fascia pain is intense when getting out of bed in
the morning or after sitting for long periods and then it subsides
after walking around a bit. Pediatric heel pain usually doesn’t
improve in this manner. In fact, walking around typically makes
the pain worse.
Heel pain is so common in children because of the very nature
of their growing feet. In children, the heel bone (the calcaneus)
is not yet fully developed until age 14 or older. Until then, new
bone is forming at the growth plate (the physis), 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.
Causes
There are a number of possible causes for a child’s heel pain.
Because diagnosis can be challenging, a podiatric foot and ankle
surgeon is best qualified to determine the underlying cause of
the pain and develop an effective treatment plan.
Conditions that cause pediatric heel pain include:
Calcaneal Apophysitis Also known as Sever’s disease, this is the most common cause
of heel pain in children. Although not a true “disease,” it is an
inflammation of the heel’s growth plate due to muscle strain
and repetitive stress, especially in those who are active or obese.
This condition usually causes pain and tenderness in the back
and bottom of the heel when walking and the heel is painful
when touched. It 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 (heel cord) and the heel bone.
Tendo-Achilles bursitis can result from injuries to the heel, certain
diseases (such as juvenile rheumatoid arthritis), or wearing poorly
cushioned shoes.
Overuse Syndromes Because the heel’s growth plate is sensitive to repeated running
and pounding on hard surfaces, pediatric heel pain often reflects
overuse. Children and adolescents involved in soccer, track, or
basketball are especially vulnerable. One common overuse syndrome
is Achilles tendonitis. This inflammation of the tendon usually
occurs in children over the age of 14. Another overuse syndrome
is plantar fasciitis, which is an inflammation of the band of tissue
(the plantar fascia) that runs along the bottom of the foot from
the heel to the toes.
Fractures Sometimes heel pain is caused by a break in the bone. 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 age of 10, another type of break—acute fractures—can
result from simply jumping 2 or 3 feet from a couch or stairway.
Diagnosis
To diagnose the underlying cause of your child’s heel pain, the
podiatric surgeon will first obtain a thorough medical history and
ask questions about recent activities. The surgeon will also examine
the child’s foot and leg. X-rays are often used to evaluate the condition
and in some cases the surgeon will order a bone scan, a magnetic
resonance imaging (MRI) study, or a computerized tomography
(CT or CAT) scan. Laboratory testing may also be ordered to
help diagnose other less prevalent causes of pediatric heel pain.
Treatment
The treatment selected depends upon the diagnosis and
the severity of the pain.
For mild heel pain, treatment options include:
Reduce Activity The child needs to reduce or stop any activity that causes pain.
Cushion the Heel Temporary shoe inserts are useful in softening the impact on
the heel when walking, running and standing. For moderate heel pain, in addition to reducing activity and
cushioning the heel, the podiatric surgeon may use one or more
of these treatment options:
Medications Nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen, help reduce pain and inflammation.
Physical Therapy Stretching or physical therapy modalities are sometimes used
to promote healing of the inflamed tissue.
Orthotic Devices Custom orthotic devices prescribed by the podiatric surgeon
help support the foot properly. For severe heel pain, more aggressive treatment options may
be necessary, including:
Immobilization Some patients need to use crutches to avoid all weight-bearing
on the affected foot for a while. In some severe cases of pediatric
heel pain, the child may be placed in a cast to promote healing
while keeping the foot and ankle totally immobile.
Follow-Up Measures After immobilization or casting, follow-up care often includes
use of custom orthotic devices, physical therapy, or strapping.
Surgery There are some instances when surgery may be required to
lengthen the tendon or correct other problems.
Prevention
The chances of a child developing heel pain can be reduced
by following these recommendations:
- Avoid obesity
- Choose well-constructed, supportive shoes that are
appropriate for the child’s activity
- Avoid or limit, wearing cleated athletic shoes
- Avoid activity beyond a child’s ability
If Symptoms Return
Often heel pain in children returns after it has been treated
because the heel bone is still growing. Recurrence of heel
pain may be a sign of the initially diagnosed condition, or
it may indicate a different problem. If your child has a repeat
bout of heel pain, be sure to make an appointment with
your podiatric surgeon.
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