In following the theme of the recent two months, this article will also be about heel pain, although this one is being addressed to parents of children with this complaint. Most children fare well while growing and usually do not have many issues as they grow and develop. Besides the usual bumps and bruises, kids make it to adulthood okay. Along the way, many kids become involved in sports and again may get a few more scrapes and scratches depending on the sport they are involved in.
This type of heel pain, however, is not usually from a bump or a scrape, typically. This one is actually quite common in active children and is referred to as Sever’s Disease and is not actually a disease, per se. It is a condition associated with active children between the ages of 8 and 13 or 14. It used to be seen primarily as a problem in boys. Since the increase in the number of sports programs for girls, this has had a rise in occurrence and has the same course of progression, as well as resolution.
Sever’s disease is actually an inflammation of the growth plate at the back of the calcaneus, the heel bone, where the Achilles tendon inserts. The Achilles is responsible for lifting the foot during walking, running and climbing, as well as other functions, which will not be addressed in this article.
When children are involved in sports such as soccer, gymnastics or baseball, there can be a tremendous amount of running and maneuvering while on the field. The Achilles is constantly pulling on the heel bone forcing it to do its job many times over. For most kids, this will never be a problem. For some, this can be uncomfortable or outright painful, which can cause an alteration in gait, especially after playing. During practices and games this may be lessened due to the warming up of the tendons and muscles. But afterwards, boy does the pain certainly return and at times it seems, with a vengeance.
For some children the cause is due to a tight Achilles tendon, calf or hamstrings or a combination of all three. It can also just be the fact that their bones are growing quicker than the muscles, ligaments and tendons. Another common ‘growth’ issue is Osgood-Schlatter’s Disease and is a similar problem that affects the bony area just below the knee where the tendon of the quadriceps muscles inserts. These conditions are commonly called or known as ‘growing pains’.
Not to fret mom and dad, but take heed to care for the knees or heels of your young superstar. When a parent presents with a child with either of these issues, X-rays are usually taken to rule out a fracture of the growth plate, or the bone for that matter. The use of Children’s Tylenol or anti-inflammatory medications can be used. Ice is always welcome to decrease any inflammation which may occur.
I prescribe, for the short term, gel heel pads for the cushion effect. This also takes some tension off a tight Achilles. I generally recommend custom orthotics, especially if there are other biomechanical issues to be addressed. These can be issues such as flat feet, limb length difference, high arches, or others. Allow a Podiatrist to evaluate, screen and treat your child. Feet is what we do all day long, every day. We know more about the conditions of the feet than any other medical discipline. So, take advantage of our knowledge and skills and experience.
