In our last blog-versation, we discussed plantar fasciitis as the most common cause of heel pain. It's true.....in adults. Children, however, rarely suffer from plantar fasciitis. The most common cause of heel pain in kids is the serious-sounding (but totally benign) Sever's Disease, also known as Calcaneal Apophysitis.
Calcaneal apophysitis is characterized not by inflammation of the plantar fascia, but by inflammation of the area of the heel where the bone is growing. The good news is that it almost always goes away on its own. It's one of the few things that a child truly will "outgrow". The bad news, though, is that the symptoms most commonly present between the ages of 9 and 11 years, but the bone doesn't stop growing until the middle or late teenaged years. So, how do we control the symptoms until then?
First, we need to make a diagnosis. X-rays are almost always taken, primarily to rule out a more serious problem (rare bone tumors, for example). Typically, kids with apophysitis will have a perfectly normal xray. A thorough history and physical exam also will be performed. Children who are couch potatoes rarely develop Sever's disease. We often see it in kids who are involved in running and jumping sports such as basketball, soccer, baseball/softball and football. The heel bone with growth plate inflammation will typically hurt when it's squeezed from both sides near the bottom of the heel. Rarely do we see redness, heat or swelling associated with this condition. Common treatments include avoidance of barefooted walking, ice/heat contrast, physical therapy, relative rest, pain relieving measures (NSAIDs or Acetominophen) and over the counter arch supports. Our favorite OTC supports are Arch Angels for small feet, and Revolution Medical Grade orthotics for larger sizes. These retail in our office for $30 and $40, respectively, but many quality inserts can be purchased at sporting goods stores for a similar price. There are also taping methods that we can teach if the child competes in gymnastics or certain types of dancing in which shoes aren't worn. Heel cups have been recommended for decades for this condition, but we haven't found them to be as effective as OTC arch supports.
When these methods aren't successful in relieving a child's symptoms, we may place them in a cast to allow the inflammation to resolve with forced rest. Prior to casting we'll often try custom foot orthotics. When a child has significant structural or functional abnormalities, we'll often try custom orthotics sooner rather than later. It's uncommon for a child to have to give up on a sport because of calcaneal apophysitis. The longer it goes on before treatment, the more resistant it may be to treatment.
Despite its imposing name, Sever's disease is not a serious condition. The pain, however, can be disabling. If your athletic child is complaining of heel pain, get it taken care of sooner rather than later. His or her coach will thank you!
