Pediatric Heel Pain

What causes heel pain in children?

Although many more adults suffer from heel pain, children do as well.  Although the main cause of heel pain in adults is PLANTAR FASCIITIS, the main cause of pediatric heel pain is something called Calcaneal Apophysitis, or Sever’s Disease.   “I tend to use the term Calcaneal Apophysitis versus Server’s Disease” states Dr. Eric Silvers of Advanced Foot and Ankle Center in McKinney and Prosper, Texas .  Dr. Silvers states, “Basically the condition is an inflammation of the growth plate (apophysis) of the heel bone (calcaneus).  When something is inflamed the medical profession will add “-itis” to the end of the part that is inflamed, i.e. calcaneal apophysitis.

What causes calcaneal apophysitis in children?

The strong Achilles tendon inserts along the back of the heel and attaches to the bone that is between a secondary growth center of the heel bone.  The heel bone has two growth centers.  The primary growth center is located in the middle of the heel bone.  Growth centers start out as cartilage and then eventually turn into bone as the bone matures.  When looking at an x-ray of a growing child you will see two boney islands separated by a boney void that represents the secondary growth plate (physis) at the back of the heel.   In some kids, mainly active children, the Achilles tendon will irritate the secondary growth plate and produce pain.  It is believed that the cause is due to overuse or micro traumas that the tendon places on the bone during activity.  It is more common to see this problem when the child is playing on hard surfaces a lot such as a basketball court or a dry soccer field.    In addition, a tight calf muscle or Achilles tendon will irritate the secondary growth plate more aggressively than a tendon that is not tight.

What are the symptoms?

Typically, calcaneal apophysitis is seen more commonly in overweight males, but since I have been in practice, I am seeing more fit females suffering from this condition.  The child will complain of pain in the back of the heel during and/or after athletic activities.  Along with pain at the back of the heel, the child at times may complain of pain along the bottom of the heel.  In addition, the heel pain is aggravated when the back of the heel is squeezed and high impact activities such as running or jumping will aggravate the problem.  One or both heels can present pain and the pain may be so acute that the child has a noticeable limp.

How is calcaneal apophysitis treated?

I typically advise my active pediatric patients who suffer from heel pain to eliminate high impact activities for a period of two weeks.  I also get them into an adjust a lift heel lift and advise them to avoid going barefoot.  Gentle stretching of the calf muscle is also helpful as is icing and Biofreeze application.  Icing the heel 3 times a day for 20-30 minutes at a time has shown good outcomes.  In cases where the child has a pronated or flat foot, a custom molded foot orthotic with a heel lift is highly advised. In more stubborn cases, oral and/or topical non steroidal anti-inflammatory medication are helpful and also cast or walking boot immobilization has been utilized in our practice.

It should be reassuring to know that the problem is self limiting and will subside once the heel bone stops growing.

If you have any questions about this condition, please call 972-542-2155 and we will be happy to help you out.

Dr. Silvers and Dr. Williams are residency trained in medical and surgical treatment of all foot and ankle problems.