Spring is almost here (I promise), and with its arrival, I always see a flood of kids in the office. What brings these children and their families in to see me? It’s almost always heel pain. And we see this heel pain most frequently in March and April, due in large part to spring sports, like soccer and baseball, that keep kids running around in cleated footwear. What’s the connection between sports, cleats and kids’ heel pain? Let’s take a closer look.
Kids’ Heel Pain is Different Than Adults
When I see heel pain in adults, the most common cause is plantar fasciitis—an inflammation of the plantar fascia, which is a band of connective tissue that runs from your heel along the base of your foot.
But that’s not the case when we see this problem in children. In fact, the most likely cause of heel pain in kids is calcaneal apophysitis. This is a very technical way of describing inflammation of the growth plate in the heel (located near the spot where the Achilles tendon attaches to the foot.) A less technical name for this condition is Sever’s Disease, but the ‘disease’ part sounds scary. Plus, it’s not actually a disease—after all, it isn’t contagious or anything—so I tend to stick with the calcaneal apophysitis description. But I digress.
Now, back to heel pain in kids. As I mentioned, you often see this kind of discomfort in young athletes, especially ones who wear cleats. Why is that the case?
We usually see this inflammation at a very specific time in your child’s life, typically when they’re in the thick of a growth spurt, or just about to start puberty. For girls, that’s usually anywhere between the ages of 8 and 13; for boys, the age range is more like 10 to 15 years.
Your kids’ feet are vulnerable in this period because, as growth rapidly accelerates, their heel bones can start growing faster than their leg muscles and tendons. If that happens, their leg muscles become tight and stretched out; this sets up a situation where their heels become less flexible. And that more rigid state puts extra pressure on developing growth plates.
Once this condition exists, putting stress on your child’s tight tendons—especially if that stress keeps coming—makes it very easy to cause aggravation to the growth plate.
This is the point at which we can understand why heel pain is common in tween athletes. You see, there’s a lot of ways you could stress out those tendons, but playing sports is a major source of this impact.
Any sport involving running and jumping (think track and field, basketball, or gymnastics) could contribute to the problem. But cleated sports, like soccer and baseball, are particularly stressful, because the athletic footwear is thin-soled, and the playing surface is hard. Together, the two conditions combine to put a lot of stress on your kids’ tight tendons. And when that happens, irritation to the growth plate can cause your child to experience swelling, tenderness and pain.
Symptoms of Sever’s Disease
Diagnosing specific conditions can sometimes be hard with children, since they aren’t always the best at describing discomfort in their bodies. Of course, complaints about heel pain—especially during athletic play—will be a big warning sign for this condition.
But you could also watch kids for signs of a slight limp—and I really mean slight. In fact, your child might not even realize it’s happening. And, the heel pain they’re feeling might not be sharp—it could present more like a dull ache, in the spot right behind their heels.
Because of the way this condition presents, a lot of grown-ups—parents and pediatricians—will dismiss the condition as growing pains. Something kids should just live with until it goes away. And, technically speaking, that’s true. Sever’s disease does, eventually, resolve, even if you don’t intervene at all. After all, the growth plate closes up at some point.
The question you have to ask yourself, however, is: what’s the time-line on eventually? And the answer, potentially, is years. Yes, that’s right. If you don’t treat your child’s heel pain, they could spend the next few years in pain. And that pain could keep them away from athletic activities, or even just casual play with friends. I’m guessing that’s not something you’d want for your child. So, instead, you’ll want to diagnose and treat your child’s foot pain. Here’s how we can do that.
Diagnosing and Treating Childhood Foot Pain
When we diagnose Sever’s disease, we take into account the history of symptoms - the patterns that are seen with when pain started, what makes it worse, what makes it better and we also take x-rays. We’ll take X-rays in order to assure there are no other obvious signs of conditions such as cysts or tumors within the heel bone (meaning, a different cause of the heel pain) and we evaluate the appearance of the growth plate. Sometimes there is evidence of a predisposition to developing apophysitis. The x-rays also assist in a deep evaluation in the structure of your child's foot which can contribute to recurrent bouts of pain in your child's heels.
Once we know that calcaneal apophysitis is the problem, we can get your child feeling better—usually quickly. Often, without major interventions! To reduce the pull of the tendon and the continual irritation, we most often fit our patients with an special brace. This helps to support the heel and achilles tendon and reduce the irritation to the growth plate. When the activity in this painful area is reduced, pain is reduced as well.
Next, we’ve got to remember that tight muscles and tendons contribute to kids’ heel pain, so utilizing icing and stretching their legs and feet at home is incorporated into treatment. If your child’s pain is really severe, we can also reduce the inflammation—and discomfort—with oral or topical anti-inflammatory medications.
Once the initial pain clears up, we’ve still got to make sure your child won’t keep coming back with the same problem. Unfortunately, some children have foot structures which make them more vulnerable to Sever’s disease. That’s why, when you bring your child in because of heel pain, I always take the time to evaluate their foot structure.
We can talk about your child’s specific biomechanics, and how they may be contributing to his or her heel pain. Then, we can discuss next-steps to prevent heel pain from coming back. One step is very simple—possibly switching to a more supportive cleat once he or she returns to athletic play.
Another very important component to completing treatment is getting fitted for a custom orthotic. The treatment plan may vary, as each case is unique as your child, but the key point to remember is this: we can easily clear up your child’s heel pain. And we can keep it from coming back…if you bring your child into the office for treatment. So, while it’s true that Sever’s disease cannot continue into adulthood, it shouldn’t progress unchecked through the teenage years. By treating Sever’s disease, you’ll not only reduce your child’s existing pain, but you’ll reduce his or her likelihood of developing other childhood foot conditions.