CHILDREN'S FOOT PROBLEMS
Heel Pain in Children - A Common Problem In Active Growing Kids
It may frequently occur after significant activities such as running or jumping. The child may have difficulty putting pressure on the heel and will begin to walk on their toes. The problem is called Calcaneal Apophysitis (calcaneal - heel bone of the foot; apoyh - growth plate; itis-– inflammation) or Severs Disease. This is an injury (not ‘disease’) to the growth plate of the heel bone, which is very common in 10 to 15 year old active children
WHAT CAUSES THE HEEL PAIN?
Think of your heel as a cushion. It contains columns of fatty tissue that allow the pad to retain its contour despite the repeated impact of walking or running. The shock absorber design also protects underlying structures within your foot. Children will often run and play barefoot. Repeatedly landing on the heel from jumping or running on hard surfaces may cause a bruising of the fat pad.
However the main reason children suffer from heel pain comes from an inflammation in and around the growth plate of the heel bone. Often there is also a problem at the point where the achilles tendon attaches to the heel. Heel pain can take the form of a sharp, burning or aching sensation. In most cases, the pain occurs on only one heel, although both feet can be affected.
Since there are several causes for heel pain, we need to pin point the exact location and it is necessary to do a thorough examination to rule out disorders such as cysts, arthritis and tendonitis. X-rays may need to be ordered to exclude these other conditions.
The 3 most common reasons for developing calcaneal apophysitis are:
1. Excessive shock to the heel
Landing heavily on the heel from a height or just overloading the heel from repeated running can aggravate the growth plate. A rigid foot type which fails to absorb shock adequately will be more likely to develop this type of heel pain.
2 . Inflexibility of the calf muscles.
Rapid growth spurt , often around puberty, can result in the long bones in the leg quickly lengthening. As the muscles have difficulty keeping up with this rapid growth they remain somewhat shortened and this
creates an inflexibility which ‘pulls’ at the achilles tendon attachment into the growth plate.
3. Mechanical imbalance in the foot
When some of us walk our feet have a tendency to roll inward, toward each other, in a motion called pronation . This motion in particular causes an abnormal pull of the achilles tendon and plantar fascia tendon (see x-ray below), which will cause the growth plate to traction or ‘pull apart’ and become inflamed.
Mechanical imbalances can cause an opposite ‘pull’ effect by the tendons that attach to the heel. The plantar fascia attaches to the large fragment of the heel and the achilles into the smaller fragment which are connected by the growth plate. These tendons create a traction or ‘pulling apart’ of the growth plate leading to inflammation.
| Mechanical imbalances can cause an opposite ‘pull’ effect by the tendons that attach to the heel. The plantar fascia attaches to the large fragment of the heel and the achilles into the smaller fragment which are connected by the growth plate. These tendons create a traction or ‘pulling apart’ of the growth plate leading to inflammation. | |
TREATMENT OPTIONS
1 . Rest as much as possible. No sporting activity for 2 weeks. Reduce any sporting activity if multiple sports are being played. However, it is sometimes very hard to rest a 10 year old.
2. Try simple physical therapy at home. Apply ice to the heel for 10 minutes or until it becomes numb. Then apply heat to the area for 5 minutes using a wheat bag. Alternate 3 times between hot and cold.
3. Stretching your calf muscles and achilles tendon, which attach to the heel is essential.
4. Strapping the heel and arch with rigid tape combined with a heel raise serves to temporary simulate the effects of an orthosis.
5. We need to protect the bone from the pulling of the achilles tendon and shoe inserts, usually orthoses will help. The orthoses will reduce the strain at the inflamed heel/plantar fascia site, which is continuously being aggravated with each step. This will provide more permanent relief and prevention until the growth plate fuses.
6. Changing footwear to a high shock absorbing shoe is appropriate.
Often the methods we have outlined will provide relief from heel pain. But remember that the problem will always resolve despite what you may have previously been told. It is a self limiting disorder which means the pain will improve as the growth plate fuses by 16 years of age.