Diagnosing a Child’s Foot Pain
It’s always disturbing to a parent when a child complains of unexplained foot pain. One common condition we see at our clinic is called calcaneal apophysitis— or the more easily pronounceable Sever’s disease.
While this is not a true disease for child’s foot pain, it is very uncomfortable and upsetting for a child, not to mention his concerned parent, who may wonder if there is something seriously wrong.
Sever’s occurs when new bone is forming at the growth plate, or apophysis, which is a weak area situated at the back of the heel. As the Achilles tendon, the strongest that attaches to the growth plate, pulls on the apophysis, it causes microtrauma and inflammation.
Children between 8 and 14 years old, whose heel bone (calcaneus) is not fully developed, can experience repetitive pounding in this area, especially if they are involved in certain sports. The stress causes inflammation, which can result in fairly intense pain and can persist for months.
Sports and Sore Feet as Cause of Child’s Foot Pain
Sever’s can affect one or both feet. It is quite common, although we see more boys than girls with this problem. After the age of 14, when the heel bone has finished growing, it usually disappears. In the meantime, it’s a relief for parents and children just to understand what’s happening.
Unlike adult foot pain, such as that caused by plantar fasciitis, Sever’s doesn’t feel better when the patient « walks it off. » In fact, walking exacerbates the problem.
One major reason that Sever’s increasingly is seen in girls is their increasing participation in sports. Track, soccer, basketball and other activities that involve running on a hard surface can all cause Sever’s.
Obesity, tight Achilles tendons or foot physiology— such as flat feet or high arches— may also contribute to foot pain.
A child suffering from Sever’s may complain of pain in the back or bottom of the heel. He or she may start to limp, especially after practice or competition. You may spot him or her tip-toeing around the house. If you squeeze the sides of the heel, he or she may report increased pain. Or you may find that your formerly gung-ho student has suddenly become reluctant to run, jump or participate in her favorite sport or activity.
These are all signs of Sever’s.
We can confirm the diagnosis with a thorough exam, noting the child’s medical history, and asking about their usual activities. X-rays and sometimes other imaging studies can be useful.
Heel Pain Treatment Options Exist
Therapy for Sever’s is fairly straight-forward. We usually advise the parents to have the child take some time away from the activity that is causing the problem. He or she could take up swimming bicycling for a while, or another activity that doesn’t require a great deal of running.
We may prescribe special shoe inserts or orthotic devices to help support the heel. Cleats are not recommended, as they tend to have little cushioning.
Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to relieve pain.
Stretching or physical therapy modalities— such as icing the heel— can be helpful. Elevating the foot may also bring some relief.
In severe cases, we may apply a cast to keep the child off his or her feet until the inflammation has healed.
To prevent a recurrence, encourage your child to stretch before his or her activity, which will help relax the muscles and Achilles tendon. Help him or her choose a sport that doesn’t involve excessive running on hard surfaces. And make sure he or she is fitted with shoes that give good support and a shock-absorbing sole.
If the pain returns after being successfully treated, it could be due to a different problem. It’s always wise to consult a doctor where your child’s health is concerned because growing bones are vulnerable in ways that adult bones are not.