Calcaneal apophysitis, also known as Sever's disease, is the most common cause of heel pain in children. Although not a true "disease," it is an inflammation of the heel's growth plate due to muscle strain and repetitive stress, especially in those who are active or obese. This condition usually causes pain and tenderness in the back and bottom of the heel when walking, and the heel is painful when touched. It can occur in one or both feet.
Diagnosis of Pediatric Heel Pain
To diagnose the underlying cause of your child's heel pain, the foot and ankle surgeon will first obtain a thorough medical history and ask questions about recent activities. The surgeon will also examine the child's foot and leg. X-rays are often used to evaluate the condition, and in some cases the surgeon will order a bone scan, a magnetic resonance imaging (MRI) study, or a computerized tomography (CT or CAT) scan. Laboratory testing may also be ordered to help diagnose other less prevalent causes of pediatric heel pain.
The treatment selected depends upon the diagnosis and the severity of the pain. For mild heel pain, treatment options include:
- Reduced activity. The child needs to reduce or stop any activity that causes pain.
- Cushioning the heel. Temporary shoe inserts are useful in softening the impact on the heel when walking, running, and standing.
For moderate heel pain, in addition to reducing activity and cushioning the heel, the foot and ankle surgeon may use one or more of these treatment options:
- Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation.
- Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed tissue.
- Orthotic devices. Custom orthotic devices prescribed by the foot and ankle surgeon help support the foot properly.
For severe heel pain, more aggressive treatment options may be necessary, including:
- Immobilization. Some patients need to use crutches to avoid all weight-bearing on the affected foot for a while. In some severe cases of pediatric heel pain, the child may be placed in a cast to promote healing while keeping the foot and ankle totally immobile. After immobilization or casting, follow-up care often includes use of custom orthotic devices, physical therapy, or strapping.
- Surgery. There are some instances when surgery may be required to lengthen the tendon or correct other problems.
Can Pediatric Heel Pain be Prevented?
The chances of a child developing heel pain can be reduced by following these recommendations:
- Avoid obesity
- Choose well-constructed, supportive shoes that are appropriate for the child's activity
- Avoid, or limit, wearing cleated athletic shoes
- Avoid activity beyond a child's ability
If Symptoms Return
Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of the initially diagnosed condition, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.