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What Is Pediatric Heel Pain?
Heel pain is a symptom, not a disease. In
other words, heel pain is a warning sign that a child has a condition that
deserves attention.
Heel pain problems in children are often associated with these signs and
symptoms:
The most common cause of pediatric heel pain
is a disorder called calcaneal apophysitis (see below), which usually affects 8-
to 14-year olds. However, pediatric heel pain may be the sign of many other
problems, and can occur at younger or older ages.
What Is the Difference Between
Pediatric and Adult Heel Pain?
Pediatric heel pain differs from the most common form of heel pain experienced
by adults (plantar fasciitis) in the way pain occurs. Plantar fascia pain is
intense when getting out of bed in the morning or after sitting for long
periods, and then it subsides after walking around a bit. Pediatric heel pain
usually doesn't improve in this manner. In fact, walking around typically makes
the pain worse.
Heel pain is so common in children because of the very nature of their growing
feet. In children, the heel bone (the calcaneus) is not yet fully developed
until age 14 or older. Until then, new bone is forming at the growth plate (the
apophysis), a weak area located at the back of the heel. Too much stress on the
growth plate is the most common cause of pediatric heel pain.
Causes of Pediatric Heel Pain
There are a number of possible causes for a child's heel pain. Because diagnosis
can be challenging, Dr. Corrigan is best qualified to determine the underlying
cause of the pain and develop an effective treatment plan.
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Calcaneal apophysitis Also known as
Sever's disease, this is the most common cause of heel pain in children.
Although not a true "disease," it is an inflammation of the heel's growth
plate due to muscle strain and repetitive stress, especially in those who
are active or obese. This condition usually causes pain and tenderness in
the back and bottom of the heel when walking, and the heel is painful when
touched. It can occur in one or both feet.
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Tendo-Achilles bursitis. This
condition is an inflammation of the fluid-filled sac (bursa) located between
the Achilles tendon (heel cord) and the heel bone. Tendo-Achilles bursitis
can result from injuries to the heel, certain diseases (such as juvenile
rheumatoid arthritis), or wearing poorly cushioned shoes.
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Overuse syndromes. Because the
heel's growth plate is sensitive to repeated running and pounding on hard
surfaces, pediatric heel pain often reflects overuse. Children and
adolescents involved in soccer, track, or basketball are especially
vulnerable. One common overuse syndrome is Achilles tendonitis. This
inflammation of the tendon usually occurs in children over the age of 14.
Another overuse syndrome is plantar fasciitis, which is an inflammation of
the band of tissue (the plantar fascia) that runs along the bottom of the
foot from the heel to the toes.
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Fractures. Sometimes heel pain is
caused by a break in the bone. Stress fractures—hairline breaks resulting
from repeated stress on the bone—often occur in adolescents engaged in
athletics, especially when the intensity of training suddenly changes. In
children under age of 10, another type of break—acute fractures—can result
from simply jumping 2 or 3 feet from a couch or stairway.
Diagnosis of Pediatric Heel Pain
To diagnose the underlying cause of your child's heel pain, Dr. Corrigan will
first obtain a thorough medical history and ask questions about recent
activities. He will also examine the child's foot and leg. X-rays are often used
to evaluate the condition, and in some cases the doctor will order a bone scan,
a magnetic resonance imaging (MRI) study, or a computerized tomography (CT or
CAT) scan. Laboratory testing may also be ordered to help diagnose other less
prevalent causes of pediatric heel pain.
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