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Don’t ignore your child’s heel pain

Heel pain is a common childhood complaint, a symptom that demands attention.  The number of pediatric patients reporting heel pain increases with the fall and winter sports seasons.  Obesity is also emerging as another prominent cause of heel pain, even with students who take physical education classes.

 

What is pediatric heel pain?

Heel pain often occurs in children between 8-14 years old.  Children may have symptoms including pain in the back or bottom of the heel, limping, walking on the toes and difficulty participating in usual activities or sports.  Heel pain is very 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, a weak area located at the back of the heel.  Too much stress on the growth plate is the most common cause of heel pain in children.  The most common disorder associated with heel pain in children is calcaneal apophysitis.

A different disorder is responsible for the most common form of heel pain in adults (plantar fasciitis/heel spur syndrome).  Usually plantar fascia pain is intense when getting out of bed in the morning or after sitting for a long time, and then subsides after walking around a bit.  Heel pain in children usually doesn’t improve in this manner.  In fact, walking around typically makes the pain worse.

 

Causes of pediatric heel pain

There are a number of possible causes for a child’s heel pain.  The child must be seen by a podiatrist to determine the cause of the pain and to develop an effective treatment plan.  Because the heel’s growth plate is sensitive to repeated running and pounding on hard surfaces, pediatric heel pain is often caused by overuse.  Children and adolescents involved in soccer, track, or basketball are especially vulnerable.  Calcaneal apophysitis (Sever’s Disease) is the most common cause of heel pain in children.  It is an inflammation of the heel’s growth plate due to muscle strain and repetitive stress, especially in children who are active in sports or are obese.  Pain and tenderness usually occurs in the back and bottom of the heel when walking, and the heel is also painful when touched.  It can occur in one or both feet.  Other causes of heel pain in children include Tendo-Achilles Bursitis, overuse syndromes (inflammation of the tendon in the back of the heel and the plantar fascia) and fractures including stress fractures.

Remember, children may not complain about their heel pain.  Several things can alert parents that their child needs attention such as limping, complaining, walking on toes, not wanting to play sports and pain in the heel the morning after a game.

 

Diagnosis of pediatric heel pain

To diagnose the underlying cause of your child’s heel pain, the podiatrist will get a full history, examine the child’s foot and leg and take an x-ray to look at the heel bone.

 

Treatment options

The treatment selected depends upon the diagnosis and the severity of the pain.  The simple RICE strategy – rest, ice, compression and elevation – often resolves the pain. The treatment options may include:

. Reduce activity: The child needs to reduce or stop any physical activity that causes pain.

. Cushion the heel: Temporary shoe inserts are useful in softening the impact on the heel when walking, running, and standing.

• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation.

• Physical therapy: Strapping, stretching or physical therapy modalities are sometimes used to promote healing of the inflamed tissue.

• Orthotic devices: Custom orthotic devices prescribed by the podiatrist can help support the foot properly. For more severe heel pain, more aggressive treatment options may be necessary.  This may include

• Immobilization: Use crutches or a cast to avoid walking and putting pressure on the affected foot while it is healing.

• Surgery: In very rare cases surgery may be required to lengthen the tendon or correct other problems that may be identified.

The following recommendations can help reduce heel pain: Avoid obesity, choose well-constructed, supportive shoes that are appropriate for the child’s activity, avoid or limit wearing cleated athletic shoes, increase activity level slowly and avoid activity beyond a child’s ability.  Wearing the appropriate shoes can play a vital role in preventing heel pain.  Use inserts to raise the heel, especially in flat-footed cleats; discard shoes that cause pain and don’t use them for another sport; wear well-constructed shoes designed for specific sports and switch cleats often because they are not supportive shoes.   The American College of Foot and Ankle Surgeons (ACFAS) stresses that athletes should never “play through the pain” in their feet.  Foot pain is not normal and your child should never play when he or she is in pain.  If your child has foot pain when playing sports, stop and see a podiatrist.  Further, do not skip warm-up or cool-down stretching exercises, which can help prevent injury.

The heel pain may re-occur because the heel bone is still growing.  However, if your child has a repeat bout of heel pain, be sure to make an appointment with your podiatrist to rule out other causes of heel pain.

For  more information on pediatric heel pain visit www.apma.org or www.footphysicians.com;  to see a podiatrist visit Bahamas Foot Centre, Rosetta Street – 325-2996 or Bahamas Surgical Associates, Albury Lane – 394-5820.

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