Heel Pain In Children

'Growing Pains,' Is There Actually Such A Thing?

Sever’s apophysitis is a condition that affects children of the ages 8-14. Boys are more commonly affected than girls. Typical symptoms include pain in the back of the heel, which is worse with and after activities. The affected foot does not normally look any different than the unaffected foot. There is no noticeable swelling or bruising. X-rays also do not show any visible pathology.

Clinically, the patient will complain of pain when the heel bone is squeezed. Normally there is no history of trauma, however, trauma can also trigger this painful condition. Predisposing factors include high level of athletic involvement (doing more than one sport at a time), body weight, tightness of the calf muscles, flat feet and improper shoes (flip flops or flats).

Although Sever’s apophysitis is self-limiting, meaning that it eventually resolves by itself, it is best to have it evaluated and treated, as it may take a long time (months and, in some cases, years) until the symptoms go away.

Due to the intensity of symptoms, aggressive treatment is recommended and includes modification of activities, rest, ice massage, anti-inflammatory medications, heel lifts in shoes, custom orthotics (inserts in shoes), calf stretches, and physical therapy. In severe cases, cast immobilization for 2-4 weeks is helpful. Overall, the prognosis for Sever’s apophysitis is excellent. Iselin’s Disease

Iselin’s disease is inflammation of the growth plate of the fifth metatarsal base. Just like Sever’s apophysitis, Iselin’s affects physically-active children between ages of 8 and 14.

The most common sports leading to this condition include soccer, gymnastics, dance and basketball. Iselin’s apophysitis is an overuse condition of the base of the fifth metatarsal. Tight calf muscles, high arch and flat foot type are predisposing factors.

Your child will complain of pain along the outer edge of the foot that is worse with activity and improves with rest. He/she may limp or walk on the inside of the foot.

The growth center may be enlarged, red, and painful to the touch as compared to the other side.

Treatments are similar to those of Sever’s apophysitis: modification of activities, ice, anti-inflammatory medications, custom orthotics, calf stretches, and in severe cases- cast immobilization.

Osgood-Schlatter

Osgood-Schlatter sounds far more frightening than it actually is. It is a common cause of knee pain in children ages 10 to 15. It occurs due to a period of rapid growth, combined with a high level of sporting activity.

Heel Pain in Children - Calcaneal Apophysitis or Sever's Disease

Children often experience heel pain. Sometimes it will be severe enough that a child will begin to limp as a result of the pain. The most common cause of heel pain is plantar fasciitis. However, plantar fasciitis is uncommon in children.

Calcaneal apophysitis or Sever's disease is the most common osteochondrosis of the foot. This is a condition that affects the cartilage growth plate and the separate island of growing bone on the back of the heel bone. This growth plate is called the physeal plate. The island of growing bone is called the apophysis. It has the insertion attachment of the achilles tendon, and it has the attachment of the plantar fascia. This island of bone is under traction from both of these soft tissue tendon and tendon-like attachments.

Mechanically, the heel takes a beating. And the apophyseal bone is located near the point of impact for the heel bone at heel strike and with most weight bearing activities. This includes running, jumping and walking. In addition to this, there is traction on this apophyseal bone and the associated physeal line of growth cartilage. This traction on the apopysis (island of bone) along with the impact of weight bearing activities can lead to inflammation and pain. Tight Achilles and calf muscles also can contribute to this problem. Heavy impact activities like soccer, football and gymnastics are commonly associated with this problem. This has been seen with boys as early as 8 years old and girls and as late as 14 year old teenagers.

Having flatfeet or very pronated feet can make one prone to this mechanically. But also patient's have a very high arch foot structure tend to have a very high shock and high impact heel strike. This also puts extra stress on the heel and apophysis. Symptoms typically include heel pain related to sports activities and worse after those sport and exercise activities. But, some children who are not in a sport may also get this if they are physically active. The pain is usually on the back of the heel, the sides of the heel, the bottom of the heel, or a combination of all of these. We typically don't see swelling with this.

Sometimes the pain is so bad the child will have to limp, or take a break from sports activity either for a few days or few months. Diagnostic evaluation can include physical examination and x-ray evaluation. It is rare to require a CT scan for this.

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