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What is Pediatric Heel Pain?


What Is Pediatric Heel Pain?

Heel pain is not uncommon in children. In fact, it occurs quite often. However, that does not mean it should ever be ignored or left untreated. You shouldn't wait to see if the pain will go away on its own. Heel pain is a symptom. It is a warning sign that your child has a problem which deserves your attention. Children who have heel pain often exhibit the following symptoms:

  • Pain in the back or bottom of the child's heel
  • Limping
  • Walking on the toes
  • Difficulty taking part in typical activities or sports

The most frequent cause of pediatric heel pain is calcaneal apophysitis. It most often affects children from eight to fourteen years old. Calcaneal apophysitis is not the only cause of pediatric heel pain, however, so it is important to get a proper diagnosis from a medical professional. Just because your child has heel pain doesn't mean they necessarly have calcaneal apophysitis. It may be a sign of many other foot issues, which may occur at younger or older ages.

What Is the Difference Between Pediatric and Adult Heel Pain?

Heel pain in children is different from the most common cause of heel pain in adults, which is plantar fasciitis. Plantar fascia pain is typically most intense when getting out of bed first thing in the morning or after sitting for long periods of time. The pain will then subside after the patient gets up and starts walking around a bit. Pediatric heel pain typically does not get better as the child moves around. Actually, walking around and being active typically makes a child's heel pain worse. Heel pain is so widespread among the young due to their growing feet. A child's heel bone, known as the calcaneus, isn't fully developed until fourteen years of age or older. Until that time, new bone is still developing at the growth plate. The growth plate is a weak area at the back of the heel. Many children suffer heel pain when too much stress is placed on the growth plate.

What Causes Pediatric Heel Pain?

If your child is suffering from heel pain, there are several potential causes. It is important to see a podiatrist for a proper diagnosis. A podiatrist is the most qualified to discover the reason of your child's pain. A podiatrist can also help you to develop an effective treatment plan once the cause has been determined.

Conditions which may cause heel pain in children include:

  • Calcaneal apophysitis, more commonly known as Sever's disease, is a frequent cause of heel pain among children. It's not a true disease. It is actually an inflammation of the heel's growth plate, most often due to muscle strain and repetitive stress. It is especially common among active or obese children. Sever's disease often causes pain and tenderness in the back and bottom of the heel when the child is active. The child's heel is typically painful when touched as well. Sever's disease may develop in just one or both of the child's feet.
  • Tendo-Achilles bursitis is an inflammation of the fluid-filled sac called the bursa, which is situated between the Achilles tendon and the heel bone. Tendo-Achilles bursitis may develop due to injuries to the heel, some diseases, like juvenile rheumatoid arthritis, or because the child is wearing shoes with poor cushioning.
  • Overuse syndromes. A child's foot is still growing and is sensitive. So, repeated running and pounding of the feet on hard surfaces, such as when a child plays sports, can cause some damage to the feet and especiallly to the sensitive growth plate. Adolescents and young children participating in sports like soccer, track, or basketball are especially susceptible to developing heel pain due to overuse. One overuse syndrome which occurs frequently is Achilles tendonitis. Inflammation of the Achilles tendon typically develops in children over the age of fourteen. Plantar fasciitis is another condition caused by overuse.
  • Fractures. Heel pain can be caused due to a break somewhere in the bone. Stress fractures are common injuries among athletes. Athletes who change their exercise regime suddenly are especially susceptible to developing stress fractures. They are basically hairline breaks which are caused by repeated stress on a bone. In youths under ten years old, acute fractures are more common and can occur from something as small as jumping two or three feet off of a couch or stairway.

How is Pediatric Heel Pain Diagnosed?

When diagnosing your child's heel pain, your podiatrist will first get your child's medical history and ask questions about recent activities your child has participated in. Your podiatrist will also examine your child's foot and leg. Often, x-rays are utilized to evaluate the child's condition. In some cases, your podiatrist may order a bone scan, a magnetic resonance imaging (MRI) study, or a computerized tomography (CT or CAT) scan. Your podiatrist may also order lab tests to help diagnose other less prevalent causes of pediatric heel pain.

What are the Treatment Options?

The treatment selected for your child will depend upon the diagnosis and the severity of your child's pain. For mild heel pain, treatments may include:

  • Reduce activity. Reduce or eliminate any activity causing pain.
  • Cushion the heel. Shoe inserts can be helpful in some cases. Shoe inserts help to soften the impact on the heel when walking, running, and standing.

For moderate heel pain, in addition to reducing activity and cushioning the heel, your podiatrist may use one or more of these treatment options:

  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, may be prescribed to help relieve pain and inflammation.
  • Physical therapy. Stretching or physical therapy are sometimes recommended.
  • Orthotic devices. Custom orthotic devices may needed for more support.

For severe heel pain, more aggressive treatment options may be utilized, such as:

  • Immobilization. Depending on the severity of your child's foot pain, different forms of immobilization may be utilized.
  • Follow-up measures. Follow-up care usually consists of wearing custom orthotic devices, physical therapy, or strapping.
  • Surgery. In some cases, surgery may be necessary to lengthen the tendon or fix other issues.

Can Pediatric Heel Pain Be Prevented?

You can help to prevent heel pain from developing in children by:

  • Avoiding obesity
  • Choosing well-constructed, supportive shoes that are appropriate for the child's activity. To see the best type of shoes, watch our video above about The Best Shoe Selection.
  • Avoiding, or at least limiting, the wearing of cleated athletic shoes
  • Avoiding 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. Heel pain recurrence 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 Neuhaus Foot and Ankle.