Heel pain is one of those symptoms we tend to associate with getting older, or working a physically strenuous job. It’s not something we would typically expect to hobble children and adolescents, especially right when they’re starting to get active with sports and other activities!
So as a parent, it can be quite concerning if one of your little ones is getting stopped in their tracks by aching or even stabbing pain in their heels. It isn’t supposed to be this way! What’s going on? Is it a sign of something more serious? And what can you do about it?
These are all very normal and natural questions to ask. And while we can’t fully answer them until we have a chance to examine your child’s feet for ourselves, we hope this blog post can provide some early guidance and help put your mind at ease.
Why Do My Child’s Heels Hurt?
The first thing to understand is that heel pain in kids, especially adolescents and “tweens,” is usually not caused by the same mechanical processes as adult heel pain.
Although kids can get more adult-like wear-and-tear injuries like plantar fasciitis or Achilles tendinitis, they are much more likely to be suffering from a condition that only appears in childhood—Sever’s disease, also known as calcaneal apophysitis.
Don’t let the word “disease” scare you. It is not a true disease. As with most other forms of heel pain (in both kids and adults), Sever’s is generally considered an overuse injury.
During this phase of life, the bones are growing rapidly. In order to achieve this growth, the ends of many bones (including the heel bone) are “capped” by a region of tissue called an epiphyseal plate, also known as a growth plate. This plate is softer than the harder, more mature surrounding bone, and thus more prone to irritation and injury.
“Sever’s disease” is simply the name we give to injuries affecting the growth plate of the heel, which is especially exposed and vulnerable. Common triggers and risk factors may include:
- Increase in physical activity (running, sports, etc.), in terms of intensity, frequency, or both. Youth athletes playing sports with a lot of running and jumping are especially vulnerable.
- Wearing shoes with poor support or cushioning.
- Having certain foot structures or postures, such as flat arches.
- Growth spurts in which the growth of the heel outpaces that of the muscles and tendons that attach to it. (Tight calf muscles or Achilles tendons can painfully tug on the heel.)
- Being overweight, obese, or simply having a very high BMI.
How Worried Should I Be About My Child’s Heel Pain?
First things first: If your child is experiencing significant heel pain, you should always bring them in to see Dr. Patel. There’s always a risk that the condition will worsen, or might actually be something other than Sever’s disease. We definitely want to make a complete evaluation and give you our personalized recommendations.
That being said, the good news is most cases of Sever’s disease are self-limiting and can usually be addressed through conservative care strategies undertaken at home. Typical episodes rarely last more than 1-2 weeks if they are managed appropriately. And of course, once the heel bone reaches full size and maturity (usually early-to-middle teens in girls and middle-to-late teens in boys), the growth plate closes into hard bone.
However, during those vulnerable adolescent years, Sever’s disease can continue to recur several times, especially if your child doesn’t take the appropriate steps to manage and prevent it. And chronic, untreated Sever’s disease can occasionally develop into more serious or longer-term issues.
So while it’s definitely not time to panic, this is a problem that you should take seriously. It’ll spare your teen a lot of pain in the long run, and help them build healthy habits and enjoy their activities!
Treating Heel Pain in Children and Adolescents
Now, the reason you probably clicked on this blog in the first place: treatment options!
As with all of our patients, we like to personalize our treatment recommendations to fit the specific needs of the individual. The best remedies for your child will depend on what caused his or her heel pain in the first place, which sports they like to play, and other factors.
Some of our typical recommendations include:
- Short-term use of cold packs and/or pain-relieving medications to help your child get through the early, painful, inflammatory phase of the condition. Always uses these methods strictly as directed, only if approved for use by your doctor.
- Temporary rest during symptom flare-ups. Your child may have to limit or discontinue sports activities that are causing pain for a short period of time.
- Make sure your child always wears appropriate shoes and gear for their activities. We always recommend sport-specific shoes in good repair, purchased new. (Used shoes typically have already “molded” to someone else’s feet, creating painful pressure spots when worn by someone else.) Check the shoe fit regularly (at least every month), as kids’ feet can grow a lot in a short period of time!
- Make smart choices in training and exercise. Sever’s disease is most common when starting a new sport, overlapping sports seasons, or transitioning from one sport to another. It’s important to avoid too many days of “high impact” play in a row without adequate rest days. It’s also a good idea to start early and slow with new sports or activities and gradually increase the frequency and intensity of training.
- If your child’s pain is related to a structural or biomechanical problem with their feet, we may recommend arch supports or custom orthotics for them to wear inside their shoes or cleats.
Teach your child that it’s important to self-monitor his or her symptoms. The temptation to hide the pain may be great, but it will only lead to more pain in the long run! Encourage them to be upfront and honest about when and how much it hurts, and if there are certain activities, sports, or shoes that seem more likely to cause pain.
Understanding these triggers—and sharing them with us—will help us tweak your child’s treatment strategy. This can help prevent future flare-ups before they begin, and make the ones that do occur less painful and easier to manage.
Prompt attention to any painful symptoms usually means much less pain and disruption in activity, both now and in the future! So if your child’s heels are hurting, make sure you make an appointment for them with Dr. Patel today!