PEDIATRIC HEEL PAIN What Is Pediatric Heel Pain? fact, walking around typically makes the heel’s growth plate due to eel pain is a common child- the pain worse. muscle strain and repetitive Hhood complaint. That doesn’t Heel pain is so common in children stress,especially in those who are mean, however, that it should be because of the very nature of their active or obese. This condition ignored, or that parents should wait growing feet. In children, the heel usually causes pain and tenderness to see if it will “go away.” bone (the calcaneus) is not yet fully in the back and bottom of the Heel pain is a symptom, not a developed until age 14 or older. Until heel when walking, and the heel disease. In other words, heel pain is then, new bone is forming at the is painful when touched. It can a warning sign that a child has a growth plate (the physis), a weak occur in one or both feet. condition that deserves attention. area located at the back of the heel. • Te n do-Achilles bursitis. This Heel pain problems in children Too much stress on the growth plate is condition is an inflammation of are often associated with these signs the most common cause of pediatric the fluid-filled sac (bursa) located and symptoms: heel pain. between the Achilles tendon (heel •Pain in the back or bottom of cord) and the heel bone. Tendo- the heel Achilles bursitis can result from •Limping injuries to the heel, certain diseases Achilles •Walking on toes tendon (such as juvenile rheumatoid • Difficulty participating in usual arthritis), or wearing poorly activities or sports cushioned shoes. Bursa • Overuse syndromes. Because the The most common cause of pediatric Physis heel’s growth plate is sensitive to (growth plate) heel pain is a disorder called calcaneal repeated running and pounding on apophysitis (see below), which usually Calcaneus hard surfaces, pediatric heel pain affects 8- to 14-year olds. However, often reflects overuse. Children and Plantar fascia pediatric heel pain may be the sign adolescents involved in soccer, of many other problems, and can track, or basketball are especially occur at younger or older ages. Causes of Pediatric Heel Pain vulnerable. One common overuse There are a number of possible syndrome is Achilles tendonitis. What Is the Difference causes for a child’s heel pain. Because This inflammation of the tendon Between Pediatric and diagnosis can be challenging, a podi- usually occurs in children over Adult Heel Pain? atric foot and ankle surgeon is best the age of 14. Another overuse Pediatric heel pain differs from the qualified to determine the underlying syndrome is plantar fasciitis, most common form of heel pain cause of the pain and develop an which is an inflammation of the experienced by adults (plantar effective treatment plan. band of tissue (the plantar fascia) fasciitis) in the way pain occurs. Conditions that cause pediatric that runs along the bottom of the Plantar fascia pain is intense when heel pain include: foot from the heel to the toes. getting out of bed in the morning • Calcaneal apophysitis. Also known • Fractures. Sometimes heel pain or after sitting for long periods, and as Sever’s disease, this is the most is caused by a break in the bone. then it subsides after walking around common cause of heel pain in Stress fractures—hairline breaks a bit. Pediatric heel pain usually children. Although not a true resulting from repeated stress doesn’t improve in this manner. In “disease,” it is an inflammation of on the bone—often occur in adolescents engaged in athletics, • Cushion the heel. Temporary shoe • Follow-up measures. After immo- especially when the intensity of inserts are useful in softening the bilization or casting, follow-up training suddenly changes. In impact on the heel when walking, care often includes use of custom children under age of 10, another running, and standing. orthotic devices, physical therapy, type of break—acute fractures—can or strapping. result from simply jumping 2 or 3 For moderate heel pain, in addition • Surgery. There are some instances feet from a couch or stairway. to reducing activity and cushioning when surgery may be required the heel, the podiatric surgeon to lengthen the tendon or correct Diagnosis of may use one or more of these treat- other problems. Pediatric Heel Pain ment options: To diagnose the underlying cause of • Medications. Nonsteroidal anti- Can Pediatric Heel your child’s heel pain, the podiatric inflammatory drugs (NSAIDs), Pain Be Prevented? surgeon will first obtain a thorough such as ibuprofen, help reduce The chances of a child developing medical history and ask questions pain and inflammation. heel pain can be reduced by following about recent activities. The surgeon • Physical therapy. Stretching these recommendations: will also examine the child’s foot and or physical therapy modalities •Avoid obesity leg. X-rays are often used to evaluate are sometimes used to promote • Choose well-constructed, support- the condition, and in some cases the healing of the inflamed tissue. ive shoes that are appropriate for surgeon will order a bone scan, a mag- • Orthotic devices. Custom orthotic the child’s activity netic resonance imaging (MRI) study, devices prescribed by the podi- •Avoid,or limit, wearing cleated or a computerized tomography (CT or atric surgeon help support the athletic shoes CAT) scan. Laboratory testing may also foot properly. •Avoid activity beyond a child’s be ordered to help diagnose other less ability prevalent causes of pediatric heel pain. For severe heel pain, more aggressive treatment options may be necessary, If Symptoms Return Tr ea t ment Options including: Often heel pain in children returns The treatment selected depends • Immobilization. Some patients after it has been treated because the upon the diagnosis and the severity need to use crutches to avoid all heel bone is still growing. Recurrence of the pain. weight-bearing on the affected of heel pain may be a sign of the For mild heel pain, treatment foot for a while. In some severe initially diagnosed condition, or it options include: cases of pediatric heel pain, the may indicate a different problem. If • Reduce activity. The child needs child may be placed in a cast to your child has a repeat bout of heel to reduce or stop any activity that promote healing while keeping the pain, be sure to make an appointment causes pain. foot and ankle totally immobile. with your podiatric surgeon. ▲ This information has been prepared by the Consumer Education Committee of the American College of Foot and Ankle Surgeons, a professional society of 5,700 podiatric foot and ankle surgeons. Members of the College are Doctors of Podiatric Medicine who have received additional training through surgical residency programs. The mission of the College is to promote superior care of foot and ankle surgical patients through education, research and the promotion of the highest professional standards. Copyright © 2004, American College of Foot and Ankle Surgeons • www.acfas.org.