Why does my child have heel pain?
Updated: Jan 14
With the onset of winter sports in Australia, we tend to see a sharp increase in the numbers of young patients presenting to the clinic with heel pain.
One of the most common diagnoses of heel pain in active children is Calcaneal Apophysitis, otherwise commonly known as Sever's Disease. This condition is ususally seen in children aged from 8-15 years, however has been seen in as young as 6 year olds. It presents as sharp pain at the base or back of the heel bone, particularly when weightbearing, and is often exacerbated by physical activity such as soccer or basketball.
Calcaneal Apophysitis is reasonably common, and has been reported to account for between 2-16% of paediatric musculoskeletal injuries. Pain is thought be due to the inflammation of the apophysis or "growth plate" at the heel bone (calcaneus), and is brought on by the traction in opposite directions between the achillies tendon and the plantar fascia. Another causitive factor is thought to be associated with the increased tension of the achillies tendon due to rapid growth in adolecence, as well as the potential strain on the apophysis due to abnormal biomechanics of the foot and ankle. Fortunately, it is a self limiting condtion, which means pain is likey to cease when the growth plate fuses with the rest of the heel bone, usually around the age of 14-15 years. However in some rare instances, left untreated, there is a risk of developing a calcaneal apophyseal avulsion fracture.
Treatment options for this condition are quite varied, ranging from rest, simple heel lifts and stretches, to more involved modalities such as orthoses and footwear modifications, to more extreme measures such as immobolisation casting and crutches in rare cases.
The best course of action for parents to consider, is to have their child assessed by a Podiatrist if there is ongoing pain in the heels, to acurately diagnose and develop an appropriate treatment plan to achieve a positive outcome, and allow the child to resume physical activity with out pain.
1. James AM, Williams CM, Hains TP: Heel raises versus prefabricated orthoses in the treament of posterior heel pain associated with calcaneal apophysitis (sever's disease): a randomised control trial. J. Foot Ankle Res. 2010, 3: 3-10.1186/1757-1146-3-3.
2. Scharfbillig RW, Jones S, Scutter SD: Sever's Disease: What does the literature really tells us? J Am Podiat Med Assn 2008, 98: 212-223.
3. Elengard T, Karlsson J, Silbernagal K: Aspects of treatment for posterior heel pain in young athletes. J Sports Med. 2010, 1: 223-232.
4. Lee KT, Young KW, Park YU, Park SY, Kim KC: Neglected sever’s disease as a cause of calcaneal apophyseal avulsion fracture: case report. Foot Ankle Int. 2010, 31: 725-728. 10.3113/FAI.2010.0725.
5. James AM, Williams CM, Hains TP: Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever's Disease): a systematic review. J. Foot Ankle Res. 2013 6:16.
*Disclaimer - this post is intended as informational only. Specific problems or issues should be discussed with your Podiatrist, Doctor or health care professional.