Kids are not just small adults. Their bodies are going through constant change. The most common reason that a child will get heel pain relates to all of these changes. In the back of the heel bone there is a large growth plate (apophysis). This usually can be seen as a wavy dark line through the back of the heel bone (calcaneus) on your child’s foot xray. Many times when a parent of a child with heel pain first sees the x-ray, they assume that line is a fracture. But it is just the growth plate and it is normal.
The reason foot doctors will take an x-ray is to 1. make sure there is no fracture or tumor of the heel bone, and 2. see whether or not the growth plate is open or closed.
Sometimes active kids will start to develop pain in the back of the heel at about the the time that the heel bone growth plate (calcaneal apophysis) starts to close. For boys this is typically around age 10-12 and age 9-11 for girls. This sort of heel pain is really just inflammation of the growth plate itself. Because ”-itis” implies inflammation doctors call this condition “ calcaneal apophysitis.” It is sometimes also known as Sever’s disease, but it is not really a “disease” like something that is contagious or that you can catch.
What causes Sever’s Disease?
An increase in activity that puts stress on the growth plate is usually responsible for starting the inflammation in the back of the heel that causes all of the pain. The classic story is a 10 year-old boy who starts playing catcher. All of that squatting down behind home-plate puts a great deal of tension on the Achilles tendon. The Achilles tendon attaches to the back of the heel.
The growth plate is between the attachment of the Achilles tendon and rest of the heel bone. Basically what happens is that any activity that pulls repeatedly on the Achilles can irritate the growth plate and cause pain. Running, jumping, squatting, gymnastics, just about any active activity that kids might enjoy can cause Sever’s disease. Muscle tightness, flat feet and pronation (when the arch collapses and the foot rolls in during walking) all potentially increase your child’s risk for this type of heel pain.
How Do I Know if My Child has Sever’s Disease?
Your child may have Sever’s Disease (calcaneal apophysitis) if:
the child is 8-12 years old
no history of trauma or sudden injury
heel pain seemed to come on gradually
child has had recent increase in activity
no swelling or bruising in the heel
the back of the heel is tender when you squeeze it
back of the heel is tender with calf muscle stretching
child complains of heel pain at night
What will the foot doctor do for my child with heel pain (Sever’s Disease)?
Your doctor visit will begin with the doctor taking a compete medical history to make sure he/she has the full story. A physical exam will be performed to make sure that there is no risk for other less common, but dangerous conditions (such as bone tumors or a heel bone fracture).
Xrays will also be taken to further evaluate the condition. Although MRI, CT scan, Ultrasound and bone scans can be performed to get more detail than can be seen on x-ray, it is very rarely necessary. MRI shows inflammation much better than an X-Ray, but MRI is usually only done if an infection, fracture or bone tumor is suspected.
Treatment of Heel Pain in Children
The good news about heel pain in kids is that it is almost always treated quickly and without surgery. Although crutches, fracture walking boots and below-the-knee casts can help speed healing, these are rarely needed.
The treatments for heel pain in kids typically target the inflammation and reduce the stress on the growth plate from the Achilles tendon. Heel cups or shoe inserts may be prescribed for this purpose. Anti-inflammatory medications may be prescribed. Icing can also help to reduce the inflammation. In some cases it may be necessary to stop the activity that is causing the problem.
The other good news is that Sever’s disease is typically “self-limiting,” meaning that it will often eventually go away without any treatment at all. In most cases, this is within a couple of weeks. Even if continuing to play catcher, most kids will eventually get over it. It just might take a little bit longer.
When to See a Foot Doctor
Any time heel pain in a child lasts more than two weeks, you should be concerned. Pain in the heel which is associated with any bruising or swelling is also worth getting checked out immediately by a foot specialist. Heel pain in a child with a fever is also very concerning and must be evaluated right away. In addition, any trauma or injury to the heel deserves medical attention right away.
Dr. Christopher is podiatrist and foot surgeon in San Francisco. As a father himself, he understands the remarkable inconvenience associated with taking a child to the doctor's office. For this reason he offers podiatry house calls in the Bay Area. His clients simply wait in the comfort of their own homes to receive expert foot and ankle care. If you think your child has heel pain that is keeping them from being active, you can reach him directly at (415) 308-0833.