Heel pain in children and teenagers is a common reason for patients to come into our office for evaluation. Although it is common, heel pain in children and teenagers should not be ignored. It is true that many causes of pediatric heel pain will “go away” as the child grows, however other causes can be serious and/or early signs of a bigger lower extremity problem. All heel pain in children should be evaluated and x-rayed to determine its cause so parents, (and children), can be educated on the type, treatment, and natural progression of the condition. Heel pain could be a warning sign that a child/teenager has a condition that needs evaluation and treatment.
Children and teenagers may complain of pain in the back of the heel, the bottom of the heel, the Achilles tendon, the arch, aching, burning, and/or swelling. Patients often complain during or after activities, complain to patients, and some may cry or refuse to participate in activities. Parents are encouraged to watch children walk and look for limping, walking on toes, rubbing their heels/feet/lower legs, or children having difficulty doing usual activities/sports. Children that play sports are especially prone to developing heel pain.
Adult heel pain and pediatric heel pain are completely different. Most adult heel pain is due to plantar fasciitis/heel spur syndrome. Adult heel pain is sharp with standing and walking that tends to “loosen up” and get a little better. Pediatric heel pain rarely is due to the plantar fascial band and usually builds with standing, walking, and activities. After activities and sports the heel often aches and throbs.
The most common cause of heel pain in children and teenagers is calcaneal apophysitis. Generally, this affects children ages 7 -15 years old, but can occur at any age of a growing child. Calcaneal apophysitis is inflammation and pain at the heel bone, (calaneus), growth plate at the back and bottom of the heels. Heavy activities, (sports, dancing, running, etc.), can stress this growth area of the heel bone by the impact of the heel on the ground and due to the strong pull of the Achilles tendon on the back of the heel. This type of heel pain resolves when the calcaneus stops growing and the growth plate closes. Calcaneal apophysitis is also known as Sever’s disease and can occur in one or both heels. Cleated athletic shoes are often associated with this condition, as cleated shoes often do not have much shock absorption and cleats directly under the heel can impact and inflame the heel bone growth plate.
Many other causes of heel pain exist and must be ruled out before apophysitis is assumed. Unicameral and other bone cysts are not uncommon, and if a cyst is present, the heel bone is at risk for collapse and fracture. Overuse of surrounding tendons and muscles can cause the heel to ache in children. The Achilles tendon attachment in the back of the heel can become irritated by shoes or by being congenitally too short. Often children and teenagers can have biomechanical abnormalities, (flatfeet, high arched feet, metatarsus adductus, etc.), than can stress and inflame soft tissue attachments to the heel. Stress fractures, traditional fractures, juvenile rheumatoid arthritis, and accessory ossicles, (extra bones), also must be ruled out as causes for pediatric heel pain.
Some tips to prevent heel pain in children and teenagers include avoiding obesity, using well-constructed, supportive, and shock-absorbing shoes, daily and regular stretching of the Achilles tendon and hamstrings, avoiding jumping from furniture/heights, and avoiding activities beyond a child’s ability.
Treatment for pediatric heel pain varies based on the type and severity of the condition. Have your child or teenager’s heel pain evaluated to ensure faster resolution of pain, a piece of mind, and to prevent future problems/conditions.
Houston Foot and Ankle
Jason C. Miller, DPM, FACFAS
Daren M. Guertin, DPM, FACFAS
Jacob Hord, DPM, FACFAS
Elizabeth Fernandez-Arias, DPM
Laura Woodcox, DPM
Laura Richards, DPM
Offices in Kingwood, Houston, Atascocita, Spring, and Mont Belvieu