Child Heel Pain And Treatments
Child heel pain can be caused by a variety of heel injuries or underlying heel condition. As there are a variety of different causes for child heel pain, there exists an equally large number of child heel pain treatments. The solution to your child’s heel pain will depend on the type of heel injury or heel condition, and the symptoms your child experiences.
Our Orthopaedic Podiatrist, Chris Parish, has more than 23 years of experience in successfully diagnosing and treating child heel pain. To discuss your child’s heel pain or condition, or to make an appointment, please contact us by phone or email, or send us a message using our simple online form
Contents
- Plantar Fasciitis in Children
- Treatment for Plantar Fasciitis in Children
- Sever’s Disease (Calcaneal Apophysitis)
- Treatment for Sever’s Disease (Calcaneal Apophysitis)
- Haglund’s Deformity In Children
- Treatment for Haglund’s Deformity in Children
- Calcaneal Stress Fractures in Children
- Treatment for Calcaneal Stress Fractures in Children
- Achilles Tendonitis (Achilles Tendinitis) and Achilles Paratendonitis (Achilles Peritendinitis) In Children
- Treatment for Achilles Tendonitis (Achilles Tendinitis) and Achilles Paratendonitis (Achilles Peritendinitis)
Child Heel Pain Causes And Treatments
Plantar Fasciitis in Children
The plantar fascia is a ligament-like structure which runs from the bottom of the heel bone (the calcaneus) to the front of the foot (see picture to the right). When it becomes inflammed, it is termed plantar fasciitis.
Plantar fasciitis can affect children and adults and the excessive tension is normally a result of poor foot function; either a flat foot (over-pronation) of a high arched foot (over supination).
Treatment for Plantar Fasciitis in Children
When your child’s heel pain is assessed by an Orthopaedic Podiatrist, they will determine the cause and any appropriate treatment. The most common treatment for plantar fasciitis will be in the form of orthotic insoles inside your child’s normal shoes. These are custom-made for your child and will reduce the tension in the plantar fascia while they walk and usually leads to a good resolution of the pain.
Sometimes stretching excercises are required if the plantar fascia is too tight. You will be shown how to do these by your Orthopaedic Podiatrist.
Sever’s Disease (Calcaneal Apophysitis)
Sever’s Disease occurs at the growth plate (‘apophysis’) of the heel bone. This is where the bone grows from and behind it is where the strong achilles tendon attaches. If the growth is interrupted it causes inflammation. This is known as Sever’s Disease or Calcaneal Apophysitis (inflammation of the growth plate). It is most common between the ages of 10 to 14 years of age.
Sever’s Disease is self limiting – it will go away when the heel bone stops growing, or maybe before. However, Sever’s Disease can be very painful and can limit normal activity of your child while they wait for it to go away, so treatment is often advised to help relieve it. In most cases of Sever’s Disease treatment works well but there are a few cases when treatment is less effective and your children may have to reduce their activity until the heel bone stops growing – usually around the age of 16.
There are no known long term complications associated with Sever’s Disease.
Treatment for Sever’s Disease (Calcaneal Apophysitis)
Management by an Orthopaedic Podiatrist for Sever’s Disease is wise. There are a few, very rare problems that may be causing the pain, so a correct diagnosis is extremely important.
Treatment for Sever’s Disease includes:
- Reducing the amount of sport your child does. They do not need to stop necessarily, just reduce it enough so the pain improves. If your child does need to stop completely, your Orthopeadic Podiatrist will advise you.
- Using an ice pack through a tea towel after sport/activity – 2 to 3 times per day for upto 20 minutes at a time.
- Avoiding going barefoot (to reduce impact on the heel).
- Cushioned heel raise (to reduce both the impact on the heel and the pull on the heel bone from the achilles tendon).
- Stretching for tight calf muscles (including the achilles tendon) as long as this does not cause pain.
If your child has a pronated foot (lowered arch / flat foot) orthotic insoles in their shoes may be reccommended.
As a pronated foot is common in children with this problem, a discussion regarding the use of foot orthotics long term may be important.
After the Sever’s Disease (Calcaneal Apophysitis) resolves, prevention with the use of stretching, good supportive shock absorbing shoes, heel raises and possible foot orthotics are important to prevent it happening again.
Haglund’s Deformity In Children
Haglund’s Deformity is a bony protrusion on the back of the heel. It can occur in one or both feet and often leads to painful “bursitis” (inflammation of the bursa, a fluid-filled sac between the tendon and the bone). In Haglund’s Deformity, the soft tissue near the Achilles tendon becomes irritated when the protrusion rubs against shoes.
Symptoms can include a noticeable bump on the back of the heel, pain in the area where the Achilles tendon attaches to the heel and swelling in the back of the heel. Redness near the inflamed tissue can also occur.
Treatment for Haglund’s Deformity in Children
After evaluating your child’s symptoms, the Orthopaedic Podiatrist will recommend one or more of the following non-surgical treatments:
- Orthotic insoles. These custom-made insoles are helpful because they control the motion in the foot, helping to lessen your child’s symptoms.
- Anti-inflammatory treatments can also help especially topical pain relievers that can be applied directly to your child’s heel.
- Stretching exercises can help relieve tension from the Achilles tendon and are especially important if your child has a tight heel cord. You will be shown how to do these with your child by your Orthopaedic Podiatrist.
- Heel lifts and pads. Children with high arches may find that heel lifts placed inside the shoe decreases the pressure on the heel. Likewise heel pads should help to cushion the heel and reduce irritation when walking.
- Physical therapy. Inflammation is sometimes reduced with certain forms of physical therapy, such as ultrasound therapy.
- Immobilisation. In extreme cases, a plaster cast might be necessary to reduce symptoms.
If non-surgical treatment fails to provide adequate pain relief, surgery may be needed. Your Orthopaedic Podiatrist will be able to advise you whether this will be necessary.
Appropriate footwear, custom-made orthotic insoles (if necessary) and stretching exercises should help to prevent a recurrence of symptoms from Haglund’s Deformity.
Calcaneal Stress Fractures in Children
A Calcaneal Stress Fracture is the name given to a very small, hairline fracture or crack, in the calcaneus. The calcaneus bone is the big heel bone at the back of the foot. In contrast to other types of fracture or breaks that may be caused by a one-off impact, a stress fracture in a bone is caused by repetitive use.
Stress fractures can occur in any bone in the body but are quite common in the weight-bearing bones of the foot. There is often no recollection of injury and most cases are associated with sports injury and overuse. Soldiers, for example, who do a lot of marching and road runners, are particularly prone.
Calcaneal Stress Fractures in children are rare and, as with adults, can sometimes be difficult to diagnose.
The heel pain is usually gradual but made worse for weight-bearing activities, and can be reproduced by squeezing the back of the heel from side to side.
Treatment for Calcaneal Stress Fractures in Children
Often an X-ray of the injured bone will not show any sign of fracture until the fracture has already started to heal some 2 to 3 weeks later. It is also possible that a stress fracture will not appear on an X-ray at all.
If your Orthopaedic Podiatrist suspects your child has suffered a Calcaneal Stress Fracture he will probably recommend they rest their foot completely for between 6 to 8 weeks, and may even suggest using crutches.
He will also look into the reason for the stress fracture to help prevent another. One question he will try to find the answer to is “Why did it happen to this foot and not the other foot?”
Achilles Tendonitis (Achilles Tendinitis) and Achilles Paratendonitis (Achilles Peritendinitis) In Children
Achilles Tendonitis refers to inflammation of the Achilles tendon, the large tendon at the back of the ankle that connects the calf muscles to the heel bone. Achilles Tendonitis can be either acute, meaning it occurs over a period of days, or it can be chronic, meaning it occurs over a longer period of time.
Achilles Tendonitis is relatively common in children and can be caused either by a growth spurt, by engaging in certain activities or by excessive twisting of the tendon caused by too much movement in the heel and leg if they ‘overpronate’. Engaging in sport or athletics without warming up properly first, running too quickly from a resting position and running up stairs or up a hill can also be factors.
The most common symptom of Achilles Tendonitis in children is pain just behind and above the heel, which can range from a short sharp period of pain during or after exercise, or it can be present all the time, particularly first thing in the morning.
Sometimes the skin covering the tendon can become swollen or red and can be very tender to the touch, even producing a squeaking sound or crackling sensation when pressed. This is especially true of Achilles Paratendonitis (also called Achilles Peritendinitis), which refers more specifically to inflammation of the outer layer of the tendon, the “paratendon”.
Treatment for Achilles Tendonitis (Achilles Tendinitis) and Achilles Paratendonitis (Achilles Peritendinitis)
The immediate treatment for Achilles Tendonitis and Paratendonitis in children (or adults) is to rest and restrict movement of the tendon.
Ice therapy can also be applied to help reduce swelling, but never directly to the skin in case of ice burn occurring. Instead, wrap an ice pack in a cloth and apply to the affected area for up to ten minutes; this can also help to numb the child heel pain.
Your Orthopaedic Podiatrist may also recommend custom-made orthotics (prescription insoles) to help prevent excessive movement in the heel, leg and foot and so prevent the return of the pain/condition. These will be made specifically to fit inside your child’s normal shoes. Measurements will be taken from lines drawn on their heels and a plaster mould will be taken of their feet to capture exact contours and structure. This exact fit is important and enables the insoles to provide maximum results.
Orthotics which are not manufactured specifically to your child’s needs can sometimes result in further pain by overstressing their muscles, bones and joints. Properly fitting custom-made orthotics will help to control movement of the foot and leg, allowing the tendon to heal more quickly.
Our Orthopaedic Podiatrist, Chris Parish, has more than 23 years of experience in successfully diagnosing and treating child heel pain. To discuss your child’s heel pain or condition, or to make an appointment, please contact us by phone or email, or send us a message using our simple online form