Heel Pain in Children



Plantar fasciitis is the most common causes of heel pain in adults but when occurs in children it’s actually the result of a condition called Sever’s disease (or calcaneal apophysitis), which most often afflicts physically active children between the ages of 8 and twelve. It is more often seen in girls than boys.

 Signs and Symptoms of Sever’s Disease

The discomfort caused by this condition is usually worse after intense physical activity such as running or sports activities, and the following symptoms will likely occur in one or both feet:
• Heel pain
• Intensified discomfort during physical activity
• Intensified discomfort immediately following physical activity
• Tenderness, swelling or redness of the heel
• Calf muscles are tight, more so upon waking
• The child begins walking forward on the toes instead of the heel

What Causes Sever’s Disease?

Sever’s disease occurs primarily when the tendons and muscles in the heel do not grow at the same rate as the heel bone, causing imbalances and discomfort in the foot. A disparity can also occur in the ratio of muscle to bone growth in the lower leg as well, which can irritate the calf muscles and the Achilles tendon as well, causing inflammation and heel pain.
Matters can also be made worse due to the length of time it takes for children’s bones to ossify, including the soft cartilage on the heel bone. If the Achilles tendon pulls on this soft spot with any regularity it can weaken this part of the foot and lead to injury and inflammation.
There may be other contributing factors to the development of Sever’s disease as well. They include the following:

• Stiffness in the lower legs, including the ankle
• The tendons of the feet are not flexible enough
• Accelerated foot growth
• Ill-fitting or insufficiently structured footwear
• Chronic minor injury to the rear of the heel

Injury to the heel and/or excessive tension may cause minor fractures to occur in the heel bone, and a prolonged presence of this affliction may leave children predisposed to knee problems, hip problems such as iliac apophysitis, or Osgood Schaltter’s disease, which occurs when the patellar tendon of the knee becomes irritated. The joint that lies between the evolving heel bone and the other bones of the foot may weaken and become susceptible to breaking. Children suffering from this type of pathology should refrain from participating in high intensity physical activity.
While Sever’s disease is often dismissed as ‘growing pains’ it can occasionally have serious consequences but the name itself should not cause any alarm as Sever’s disease is not a disease but a temporary imbalance of tendon and bone growth.

Treatment and Prevention of Children’s Heel Pain

The only reliable treatment for Sever’s Disease is time, but there a few things that can be done to reduce the child’s pain and debilitation levels:
• Consistent stretching of the legs, ankles, and feet will help keep muscles flexible and reduce heel pain in children.
• Running and jumping on hard surfaces such as cement should not be allowed.
• Participation is sports and intense exercise must be minimal.
• Shoes that fit properly and provide good support should be worn during weight bearing activities.
• Ice packs should be used to reduce pain and inflammation: 10 minutes of ice should be efficient.
• The introduction of orthoses will help to minimize hyper-pronation and reduce the amount of tension that the Achilles tendon must bear.

The only cure for Sever’s Disease is time; most children outgrow this condition by the time they are 10 years old. Until then there are several choices that can be made to decrease heel pain in children and prevent the condition from becoming worse or creating secondary problems.

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