Heel Pain In Children

Keeping active is a basis for a healthy lifestyle, but overuse of specific areas of the body can lead to injury. Active children between the ages of 8 and 14 are susceptible to inflammation of the growth plates in their feet when they spend a lot of time engaging in high-impact activities like running and jumping.

What Is the Growth Plate?

The heel bone, or calcaneus, is not fully developed in children until they are 14 or 15 years old. While children are still growing, the bone has an apophysis — or outgrowth or bone — that is open to allow for the growth and development of the bone. This apophysis is commonly referred to as a growth plate. When the bone is fully developed, the growth plate closes.

Sever's Disease

In some children, the calcaneus apophysis can become inflamed due to strenuous activity that involves repeated stress on the heel bone. The inflammation is called calcaneus apophysitis and typically occurs in children 8 years or older and can last until the bone has fully developed, around the age of 14 or 15. It doesn't occur as a result of a specific injury but develops over time. Another name for this inflammation is Sever's disease. 

Heel Stressors

Kids who play sports that involve a lot of running are more likely to develop Sever's disease. Repeated stress on the heel and the growth plate while playing soccer, basketball, or running cross country or track can cause the onset of inflammation. Running on a hard surface or running in cleats can exacerbate the problem. 

Some children have a predisposition to Sever's disease because of their anatomy. A tight Achilles tendon puts pressure on the heel bone. Foot arches that are too high or too flat can also cause inflammation of the calcaneus apophysis.  

Symptoms and Diagnosis

The first sign of Sever's disease is typically heel pain when walking or running. Kids will often limp or walk on their toes to avoid the pain that occurs when the whole foot makes contact with the floor or ground. Pain increases as the force of impact increases, becoming worse during activities that involve running or jumping. Some children find that the pain is worse when they wake up, despite having rested during the night. 

A podiatrist can test the heel for tenderness under compression and examine the flexion and extension of the ankle and foot. The doctor will also order X-ray images to be taken of the foot that is experiencing pain, or both feet if necessary. The exam, images, and history of the child's activities allow the doctor to diagnose the condition and formulate a plan for treatment.

Treatment Options

The first step to recovery is rest. Taking a break from sports and running in general will help lessen the inflammation, which can be helped by taking anti-inflammatory medication as needed. Stretching exercises that focus on loosening the tension of the Achilles tendon will help reduce the pressure on the heel bone and should be done multiple times per day.

Orthotic shoe inserts may be needed to provide support to the heel and lessen the impact that occurs when walking. In severe cases, the heel may need to be immobilized to reduce inflammation. A cast takes the pressure off the foot and allows the growth plate to heal without the risk of reinjury. For more information, reach out to a podiatry doctor today.