Heel Pain in Kids

What is heel pain in kids?

Heel pain in kids, or paediatric heel pain, is a common complaint and typically affects 8-14 year old children. Heel pain is a symptom and not a disease; it is an indicator that there is a condition present that requires medical attention.

Heel pain in kids is usually different from the most common type of heel pain that adults experience. Adult heel pain typically goes away, or at least improves somewhat after a period of walking, whereas heel pain in kids doesn’t generally improve this way, and conversely in most cases, walking or physical activity actually makes it worse.

What causes heel pain in kids?

There are a number of conditions that can cause heel pain in kids. Quite often, the cause of heel pain in kids is the result of an overuse syndrome, affecting the calcaneal apophysis or the associated structures, known as Sever’s disease (calcaneal apophysitis). At the back of the heel bone on each foot, there is an area- referred to as a growth plate- where the Achilles tendon and the plantar fascia attach. This is called the calcaneal apophysis, and usually first appears in kids aged between 7 and 8 years old. By the age of about 14, the growth plate matures from being cartilaginous, into bone. Sever’s disease is the most common problem affecting 8-14 year olds, however bursitis, juvenile rheumatoid arthritis, Achilles tendonitis, plantar fasciitis and fractures are not entirely uncommon in growing children.

Sever’s Disease (Calcaneal Apophysitis)

Sever’s disease is the most common condition that causes heel pain in kids aged between 8 and 14 years old. Excessive tension and stress on the calcaneal apophysis causes inflammation and irritation in the area. Children suffering with Sever’s disease will usually complain of pain that feels like a bruise, and it gets worse as the exercise continues. There is usually no visible swelling or bruising. Sever’s disease is most common in children that participate in running or jumping sports, such as basketball, soccer, athletics or gymnastics.

Risk factors for Sever’s disease causing heel pain in kids

Sever’s disease develops and causes heel pain in kids due to factors such as:

• changes in the height and weight of the child (particularly during growth spurts)
• the type of physical activity the child participates in; Sever’s disease is most common with sports involving a lot of running and jumping, such as basketball, soccer, football, netball, gymnastics
• an increase in the volume, frequency, intensity or duration of physical activity that the child is engaged in; such as in the following circumstances, for example:
  • a child starts training and playing for a sports team (exercise increases to multiple training and game sessions per week)
  • a child is involved in a tournament where multiple games are played in a day or over the course of a few days
  • there is a crossover in the sports a child participates in
  • one sports season finishes and another immediately begins
• the type of shoes worn, or whether the child is playing sport barefoot or in flip-flops
• foot posture and gait: children with flat arches are more likely to suffer from Sever’s disease
• overweight or obesity increases the risk of Sever’s disease.

Other causes of heel pain in kids

Other than Sever’s disease, some other causes of heel pain in kids include:

• Bursitis: inflammation of the bursae. Bursae are the small fluid-filled sacs located between structures in the body, whose function is to lubricate moving parts and reduce friction. Bursitis can occur at the back of the heel due to injury, overuse or wearing tight-fitting shoes
• Juvenile rheumatoid arthritis: causes swelling and stiffness of the joints, and persistent and restrictive pain
• Achilles tendonitis: an inflammatory condition affecting the Achilles tendon at the lower part of the back of the leg, where it attaches to the heel bone. Usually occurs due to overuse in children over 14
• Plantar fasciitis: inflammation of the plantar fascia, which is the thick, ligament that connects the heel bone to the toes, along the bottom of the foot. Usually a result of overuse or flat foot posture and often in children over 14
• Fractures: can occur from impact from falling on the heel.

Diagnosing the cause of heel pain in kids

When determining the cause of heel pain in kids, the sports podiatrist will undertake a thorough physical examination of the child’s painful heel. They will consider signs such as where the pain is centred, whether there is pain across the Achilles tendon or plantar fascia, or any tightness in the calf muscles. An x-ray may be ordered so that the podiatrist can determine how mature the calcaneal apophysis is, since the cartilaginous, active growth plate appears different from the mature, fused bone on imaging. X-rays are also useful as they may show other causes of heel pain such as stress fractures.

How is heel pain in kids treated?

Treating heel pain in kids is quite often centered on relieving inflammation. The sports podiatrist may suggest various treatments depending on the individual’s diagnosis. Common treatment options include:

• Resting or modifying physical activity to limit high-impact movements and running, to reduce the pain by allowing the heel to rest
• Safe stretching and strengthening as directed by the sports podiatrist
• Heel support in the form of heel lifts or cups, or new shoes as suggested by the sports podiatrist, if appropriate for the individual patient.
• Reducing inflammation through the use of ice packs and as a last resort NSAIDs (non-steroidal anti-inflammatory drugs, such as ibuprofen)

It is worth noting that if the heel pain has been diagnosed as Sever’s disease, it will likely resolve on its own when the growth plate matures at around 12-13 years for girls, and 13-14 years for boys.

Is heel pain in kids preventable?

While preventing heel pain in kids altogether may not be possible, taking some simple considerations when it comes to physical activity can reduce the likelihood of the child developing pain from overuse:

• Assist and encourage your child to maintain a healthy bodyweight so as to avoid undue stress on the ankles and feet
• Choose appropriate footwear for their sport (your sports podiatrist can assist you in making a sound choice)
• Gradually increase exercise rather than changing training or playing schedules abruptly.

Please note that the content provided in the above article should not be taken as general medical advice. If your child is complaining of heel pain or you would like to discuss heel pain in kids with our qualified sports podiatrists, please make an appointment by emailing [email protected] or by calling 0293883322.

Karl Lockett – sports podiatrist.