Pediatric Heel Pain

Pediatric Heel Pain

Heel pain is a common childhood complaint. That doesn't mean, however, that it should be ignored, or that parents should wait to see if it will "go away."

Heel pain problems in children are often associated with these signs and symptoms:

  • Pain in the back or bottom of the heel.
  • Limping
  • Walking on toes
  • Difficulty participating in usual activities or sports

Calcaneal apophysitis or Sever's Disease is the most common cause of heel pain in children between the ages of 8 and 15. Although not a true "disease," it is an inflammation of the heel's growth plates due to rapid growth, muscle strain and repetitive stress, especially in those who are active or obese. With this condition, pain is usually felt at the back and side of the heel bone or even the bottom of the heel. Pain usually worsens when the heel bone is squeezed or when the child is running or jumping. It can occur in one or both feet.

Other causes for pediatric heel pain include:

  • Tendo-achilles bursitis. This condition is an inflammation of the fluid-filled sac (bursa) located between the Achilles tendon (heel cord) and the heel bone. Tendo-Achilles bursitis can result from injuries to the heel, certain diseases (such as juvenile rheumatoid arthritis), or wearing poorly cushioned shoes.
     
  • Achilles tendonitis and Overuse syndromes. Because the heel's growth plate is sensitive to repeated running and pounding on hard surfaces, pediatric heel pain often reflects overuse. Children and adolescents involved in soccer, track, or basketball are especially vulnerable. One common overuse syndrome is Achilles tendonitis. This inflammation of the tendon usually occurs in children over the age of 14. Another overuse syndrome is plantar fasciitis, which is an inflammation of the band of tissue (the plantar fascia) that runs along the bottom of the foot from the heel to the toes.
     
  • Fractures. Sometimes heel pain is caused by a break in the bone. Stress fractures -- hairline breaks resulting from repeated stress on the bone -- often occur in adolescents engaged in athletics, especially when the intensity of training suddenly changes. In children under the age of 10, another type of break -- acute fractures -- can result from simply jumping 2 or 3 feet from a couch or stairway.

As you can see there are a number of possible causes for a child's heel pain. Because diagnosis can be challenging, a podiatric foot and ankle surgeon is best qualified to determine the underlying cause of the pain and develop an effective treatment plan. To diagnose the underlying cause of your child's heel pain, the podiatric surgeon will first obtain a thorough medical history and ask questions about recent activities. The surgeon will also examine the child's foot and leg. X-rays are often used to evaluate the condition and in some cases the surgeon will order a bone scan, a magnetic resonance imaging (MRI) study, or a computerized tomography (CT or CAT) scan. Laboratory testing may also be ordered to help diagnose other less prevalent causes of pediatric heel pain.

Pediatric heel pain vs. adult heel pain

Pediatric heel pain differs from the most common form of heel pain experienced by adults (plantar fasciitis) in the way pain occurs. Plantar fascia pain is intense when getting out of bed in the morning or after sitting for long periods and then it subsides after walking around a bit. Pediatric heel pain usually doesn't improve in this manner. In fact, walking around typically makes the pain worse.

Heel pain is so 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 (the physis), a weak area located at the back of the heel. Too much stress on the growth plate is the most common cause of pediatric heel pain.