In growing children, the most common cause of heel pain is Sever’s Disease, or calcaneal apophysitis. This condition begins when the growth plate that is at the back of the heel, or calcaneus, becomes inflamed and painful. Children that are active and play sports or exercise regularly have a higher likelihood of developing the condition.
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Symptoms
Children often present with pain and swelling on the back of the heel. There can be increased warmth to the area as well. Pain touching the area is often indicative of Sever’s disease. Pain to the sides and bottom of the heel are also not uncommon. Limping after running or jumping and stiffness after sitting for long periods or sleeping are typical presentations too.
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Causes
The cause of Sever’s disease is repetitive stress on the growth plate at the back of the heel bone, where the Achilles tendon attaches and pulls. Since patients undergoing a rapid growth spur are more susceptible to developing inflammation at the growth plate, the typical ages of presentation in girls is 8 to 13 and boys 10 to 15. The growth plate is a soft area of cartilage where bone growth occurs. The Achilles tendon connects the calf muscles to the heel bone in the area of the growth plate. Activities that increase the pull of the Achilles tendon on the heel, such as running and jumping, can irritate the heel growth plate. Overuse and improper shoes are also causes for possible growth plate injuries.
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Treatment
First and foremost in order to treat Sever’s disease, rest and time off of intense activities is a must. Gentle stretching of the calf muscles can help reduce the stress on the heel, but may not be tolerated when acutely painful. Physical therapy plays a large role in the stretching and strengthening of the leg muscles and tendons. An evaluation with a Chiropodist or Pedorthist is recommended due to the development of the child. Icing the heel may be recommended to decrease the present inflammation. A Chiropodist can evaluate the use of over-the-counter nonsteroidal anti-inflammatory medications to help reduce pain and swelling of the growth plate. A Canadian Certified Pedorthist evaluation is helpful in order to adjust shoes or offer advice on footwear and provide orthotics with heel lifts that will cushion the heel and reduce tension to the Achilles tendon.
