Foot pain is not only limited to grown-ups. Often, healthy and active children will complain of pain in one or both heels shortly after running, engaging in sports or even walking. The pain is centered at the back of, or under the heel. The cause of heel pain in children is usually a condition called calcaneal apophysitis, normally reported by 8 to 14 year olds.
During the growth spurt of early puberty, the heel bone sometimes grows faster than the leg muscles and tendons. This can cause the muscles and tendons to become very tight and overstretched, making the heel less flexible and putting pressure on the growth plate. The Achilles tendon is the strongest tendon that attaches to the growth plate in the heel. Over time, repeated stress, from physical activities and sports, on the Achilles tendon damages the growth plate, causing the swelling, tenderness, and pain of Sever’s disease.
Sever condition causes pain at the back of the heel. The pain is increased with plantar flexion of the ankle (pushing down with the foot as if stepping on the gas), particularly against resistance. Sever condition also causes tenderness and swelling in the area of the pain.
Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a “squeeze test” and some other tests to confirm the diagnosis. Some children suffer Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors thought to predispose a child to Sever?s disease include a decrease in ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing activities eg running.
Non Surgical Treatment
The aims are to reduce trauma to the heel, allow rest/recovery and prevent recurrence. Most cases are successfully treated using physiotherapy and exercises, eg to stretch the gastrocnemius-soleus complex, to mobilise the ankle mortise, subtalar joint and medial forefoot. Soft orthotics or heel cups. Advice on suitable athletic footwear. Other modes of treatment are in severe cases, temporarily limiting activity such as running and jumping. Ice and non-steroidal anti-inflammatory drugs (NSAIDs), which can reduce pain. In very severe cases, a short period of immobilisation (eg 2-3 weeks in a case in mild equinus position) has been suggested.
Can Calcaneal Apophysitis Be Prevented? The chances of a child developing heel pain can be reduced by avoiding obesity. Choosing well-constructed, supportive shoes that are appropriate for the child?s activity. Avoiding or limiting wearing of cleated athletic shoes. Avoiding activity beyond a child?s ability.