Overview
Heel pain is common in children. While it can occur after a specific injury, it is also commonly caused by Sever's disease, a type of overuse syndrome, like shin splints or Osgood-Schlatter?s disease. Children with Sever's disease, which is also called calcaneal apophysitis, develop inflammation where the Achilles tendon inserts at the calcaneus, or heel bone. This inflammation causes pain, which can vary depending on the type of activity your child is doing, and is generally worse after activity(such as running and jumping) and improves with rest. Sometimes squeezing the heel can cause pain and occasionally it can be felt under the heel.
Causes
The large calf muscles attach to the heel via a large tendon called the Achilles tendon (See image below). The function of this tendon is to transmit forces produced by the calf muscles to the heel bone. In children, the portion of the heel bone into which the Achilles tendon inserts is separated from the bulk of the heel bone by a growth plate. This growth plate enables bone growth to occur. However, it also represents a site of weakness in the bone. Forcible and repeated contraction of the calf muscles can injure the growth plate. This commonly occurs during a period of rapid growth where the muscles and tendons become tighter as the bones grow. This leads to increased pulling of the calf muscles and Achilles tendon on the heel bone and growth plate.
Symptoms
Children aged between 8 to 13 years of age can experience Sever?s disease with girls being normally younger and boys slightly older. Sever?s disease normally involves the back of the heel bone becoming painful towards the end of intense or prolonged activity and can remain painful after the activity for a few hours. Severe cases can result in limping and pain that can even remain the next morning after sport.
Diagnosis
To diagnose the cause of the child?s heel pain and rule out other more serious conditions, the foot and ankle surgeon obtains a thorough medical history and asks questions about recent activities. The surgeon will also examine the child?s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.
Non Surgical Treatment
The disease can be treated easily and is considered to be temporary, if treated promptly and correctly. If left untreated or if treated improperly, the disease can result in a permanent heel deformity, causing future shoe-fitting difficulties. Other long-term effects can include foot arch problems, potentially resulting in plantar fasciitis or heel spurs and tight calf musculature, which can lead to Achilles tendonitis. The American College of Foot and Ankle Surgeons recommends the following steps, once Sever?s disease has been diagnosed. Reduce or stop any activity that causes pain. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help reduce the pain and inflammation. Stretching and/or physical therapy may be used to promote healing. In severe cases, a cast may be used to keep the foot and ankle immobilized during the healing process.
Recovery
If the child has a pronated foot, a flat or high arch, or another condition that increases the risk of Sever's disease, the doctor might recommend special shoe inserts, called orthotic devices, such as heel pads that cushion the heel as it strikes the ground, heel lifts that reduce strain on the Achilles tendon by raising the heel, arch supports that hold the heel in an ideal position, If a child is overweight or obese, the doctor will probably also recommend weight loss to decrease pressure on the heel. The risk of recurrence goes away on its own when foot growth is complete and the growth plate has fused to the rest of the heel bone, usually around age 15.
Heel pain is common in children. While it can occur after a specific injury, it is also commonly caused by Sever's disease, a type of overuse syndrome, like shin splints or Osgood-Schlatter?s disease. Children with Sever's disease, which is also called calcaneal apophysitis, develop inflammation where the Achilles tendon inserts at the calcaneus, or heel bone. This inflammation causes pain, which can vary depending on the type of activity your child is doing, and is generally worse after activity(such as running and jumping) and improves with rest. Sometimes squeezing the heel can cause pain and occasionally it can be felt under the heel.
Causes
The large calf muscles attach to the heel via a large tendon called the Achilles tendon (See image below). The function of this tendon is to transmit forces produced by the calf muscles to the heel bone. In children, the portion of the heel bone into which the Achilles tendon inserts is separated from the bulk of the heel bone by a growth plate. This growth plate enables bone growth to occur. However, it also represents a site of weakness in the bone. Forcible and repeated contraction of the calf muscles can injure the growth plate. This commonly occurs during a period of rapid growth where the muscles and tendons become tighter as the bones grow. This leads to increased pulling of the calf muscles and Achilles tendon on the heel bone and growth plate.
Symptoms
Children aged between 8 to 13 years of age can experience Sever?s disease with girls being normally younger and boys slightly older. Sever?s disease normally involves the back of the heel bone becoming painful towards the end of intense or prolonged activity and can remain painful after the activity for a few hours. Severe cases can result in limping and pain that can even remain the next morning after sport.
Diagnosis
To diagnose the cause of the child?s heel pain and rule out other more serious conditions, the foot and ankle surgeon obtains a thorough medical history and asks questions about recent activities. The surgeon will also examine the child?s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.
Non Surgical Treatment
The disease can be treated easily and is considered to be temporary, if treated promptly and correctly. If left untreated or if treated improperly, the disease can result in a permanent heel deformity, causing future shoe-fitting difficulties. Other long-term effects can include foot arch problems, potentially resulting in plantar fasciitis or heel spurs and tight calf musculature, which can lead to Achilles tendonitis. The American College of Foot and Ankle Surgeons recommends the following steps, once Sever?s disease has been diagnosed. Reduce or stop any activity that causes pain. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help reduce the pain and inflammation. Stretching and/or physical therapy may be used to promote healing. In severe cases, a cast may be used to keep the foot and ankle immobilized during the healing process.
Recovery
If the child has a pronated foot, a flat or high arch, or another condition that increases the risk of Sever's disease, the doctor might recommend special shoe inserts, called orthotic devices, such as heel pads that cushion the heel as it strikes the ground, heel lifts that reduce strain on the Achilles tendon by raising the heel, arch supports that hold the heel in an ideal position, If a child is overweight or obese, the doctor will probably also recommend weight loss to decrease pressure on the heel. The risk of recurrence goes away on its own when foot growth is complete and the growth plate has fused to the rest of the heel bone, usually around age 15.