Heel pain in children is quite different than the same complaint in adults.
What is kid's heel pain? Can my child have plantar fasciitis like me?
Heel pain is a common childhood complaint, seen in young athletes as well as overweight children. While it used to be thought of as more common for boys, now we see plenty of young girls with the exact same complaints. That doesn’t mean, however, that it should be ignored, or that parents should wait to see if it will “go away.”
Heel pain itself is not a diagnosis, but yet a symptom of a bigger problem that needs an accurate diagnosis and prompt treatment.
- Pain at the bottom, back or sides of heel
- Pain with shoes
- Inability to play sports or usual activities
- Lifting weight off heels/walking on toes
- Needing more rest/wanting to put their feet up
- Asking to have their feet rubbed
So what makes kid's heel pain different?
The most common form of heel pain experienced by adults is plantar fasciitis. 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 with walking. Children will typically attempt to compensate or rest the area by limping or avoiding shoes. Shoes actually make Plantar Fasciitis feel better.
Children have growing feet, thus they have growth plates present. This is wear the bones gain their length and/or width. The growth plate at the back of the heel bone (calcaneus) is the most common growth plate in the foot to suffer injury due to pounding and impact.
Causes of heel pain
Calcaneal Apophysitis Also known as Sever’s disease, this is the most common cause of heel pain in children. This is an inflammation of the heel’s growth plate due to repetitive stress and impact. This is especially common in active young athletes and overweight children. This condition is hallmarked by pain and tenderness in the back and bottom of the heel worsened by sports, shoes, running and walking. While X-rays are often taken, this is a diagnosis by exam. When pressure is placed on the growth plate, the pain is intensified.
Achilles Tendinitis This condition is an inflammation heel cord, typically as the tendon attaches to the heel bone. This is usually brought on by a tight heel cord and a lack of stretching. It is most common in children who increase their sport time quickly, for example at the beginning of the season, or nearing the playoffs or championships. This is differentiated from a growth plate injury by the location of the pain. Commonly the above 2 are seen together in the same patient.
Fractures This is the most infrequent source of heel pain, but still can be the cause. This can range from a full fracture of the bone to a piece of chipped bone to a stress fracture. Stress fractures are tiny, hairline breaks resulting from repeated stress on the bone, often occur without injury. Most commonly seen when a child quickly increases activity or intensity of activity.
What to expect in the office
The best way to determine what is causing the heel pain is a thorough history of the problem and exam by the doctor. X-rays will also be taken to check the growth plate and heel bone for any abnormalities. In difficult cases sometimes a bone scan, MRI or CT scan are needed to further evaluate the problem.
There are many treatment options and not all may be right for your child. The following is a list of possible treatment that may be instituted:
- Inserts or heel cushions
- Change in shoe gear
- Anti inflammatory medication
- Education of the parents and child
- Physical Therapy
- Break from sports or activity
- Walking boot
- Custom orthotics
If Symptoms Return
Heel pain can recur until the growth plate is closed. This is usually around age 14 for boys, 12 for girls. If the pain becomes recurrent, custom orthotics and a thorough athletic shoe evaluation are needed by a podiatrist who actively treats children.