Warning —Your Child’s Heel Pain is Not Normal

Warning —Your Child’s Heel Pain is Not Normal

By Rebecca Moellmer, DPM, FACFAS, FAAPSM

Western University of Health Sciences College of Podiatric Medicine Assistant Professor, Podiatric Medicine, Surgery & Biomechanics

Pomona, CA -- The most common cause of heel pain in 8-15 year-olds is called Sever’s Disease and it is seen in physically active adolescents, both boys and girls. It is commonly associated with sports participation and due to high impact activities, such as running and jumping. The heel pain is caused by inflammation of the growth plate caused by, most commonly, a tight Achilles tendon but also can be exacerbated with excessive flat arches or high arches.

The anatomy of a child’s heel is a main heel bone and a posterior “island” of bone, separated by a soft cartilaginous growth plate where the body places bone as the heel grows. When the Achilles pulls up at the posterior island of bone and the body weight of the child pushes the main heel bone down it causes inflammation and pain due to a sheering force at the growth plate.

Sever’s Disease is diagnosed based off of a doctor’s clinical findings and history. A child will often complain of pain with activity and have pain at the back of the heel or pain with squeezing the heel. Sometimes there is pain on the bottom of the heel. There is not usually pain along the Achilles tendon and there is not visible swelling or discoloration with Sever’s Disease. Heel x-rays have been found to look very similar in all adolescents with open growth plates, with or without Sever’s Disease, therefore x-rays are not necessary initially.

Treatment of Sever’s Disease consists of decreasing the sheer force on the soft cartilaginous growth plate of the heel. Initial treatments consist of heel lifts/cups that will elevate the heel minimally and put the Achilles tendon on slack, therefore reducing the pull of the Achilles on the bony island. Applying ice for several minutes after activities will reduce the inflammation of the growth plate that causes pain. Anti-inflammatory oral medication is an option for inflammation control, as well. Physical therapy exercises to lengthen the Achilles tendon may also be successful in reducing the pull of the Achilles on the bony island. Receiving education regarding proper shoe gear for each child’s foot type and sport is imperative for injury prevention. If heel lifts are successful and if the child was found to have excessive flattening or high arches leading to increased pressure on the heel, custom molded orthotics should be considered. If the previous treatments are unsuccessful at relieving symptoms, taking time away from the activity or sport is often enough to relieve the symptoms.

Fortunately, the prognosis of Sever’s Disease is good. Treatments are successful at relieving the symptoms and this disease never requires surgery.

Heel pain is not normal. If your child limps, wants to be carried instead of walking or complains of pain during physical activities… it is time to consider seeing a specialist in Podiatric Medicine.

Inland Valley News, May 15, 2014