Children’s heel pain
Calcaneal apophysitis (Sever’s disease) is the most common cause of heel pain in children 5 to 13 years of age. Pain at the apophysis (growth plate in the heel) is caused by repetitive microtraumor traction of the calf muscles at the heel. Calcaneal apophysitis is commonly seen in children participating in football, basketball, soccer and other running activities. Patients with calcaneal apophysitis may have activity-related pain in the posterior aspect of the heel, and 60% of patients report pain in both heels. Examination by a podiatrist may reveal tenderness when compressing the back of the calcaneus (heel bone) (see picture). X-rays of the calcaneus may appear normal or may reveal an inflammed calcaneal growth plate. Treatment consists of activity modification, icing, stretching of the calves, pain medications and heel lifts. Most patients are able to return to pain-free activity within three to six weeks.
Recently I have started seeing many children coming into my clinic suffering acute heel pain. Often the pain occurs in both heels and causes the child to noticeably limp and may force them to reduce their activity. It is very common in children who are active and can severly restrict their level of activity without proper treatment. Sever’s disease often occurs during the transition from summer to winter sports when the activity, shoewear and ground surfaces are very different. Football boots in particular place greater strain on the heel due to the increased heel drop and can consequently lead to calcaneal apophysitis. It is very important to be properly assessed by a podiatrist to ensure the correct diagnosis is made and the appropriate steps are put in place to allow the child to return to sport without pain as quickly as possible.
Andrew Maitland is a sports podiatrist at the Melbourne Podiatry Clinic. Having worked closely with many elite and amateur runners over the years he has helped many people in the prevention and treatment of running injuries.