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Kids' Feet

Pediatric Heel Pain: Causes and Treatment Options

Heel pain is common among children. While the condition is typically not serious, proper diagnosis and prompt attention is important.

Children that limp, walk on their toes, experience tenderness in the back of the ankle or foot, or complain of heel pain might have calcaneal apophysitis or Sever’s disease or might be suffering from an injury like Achilles tendinitis.

Injuries to the heel and foot usually develop gradually and are often attributed to overuse and possibly inappropriate shoewear. This is especially true among children who are engaged in competitive sports and have rigorous training regimens. Fortunately, overuse injuries often respond to rest and noninvasive treatment measures.

Below are some of the most common causes of heel pain among children and ways to manage them.

Achilles tendinitis

Achilles tendinitis can often occur as a result of drastic changes in activity. Responsible for attaching the two muscles of the calf to the heel bone, the Achilles tendon also helps in propelling the body forward when running or walking.

When inflamed, it can lead to swelling, walking difficulty, and pain at the back of the foot or the heel. Pain can start off as mild but may get worse over time.

Children who perform repetitive activities like jumping, running, pivoting—dancers, basketball players, etc.—are more prone to developing Achilles tendinitis.

Treatment

Treatment for the condition includes rest, ice, compression, and stretching. Transcutaneous medicated plasters may also help. Using a sports tape or an elastic wrap to support the tendon and minimize the swelling may also help. Anti-inflammatory medications like ibuprofen may also be prescribed to help ease the pain and reduce the swelling. Stretching exercises for the calf muscles and the ankle may also assist in the recovery.

To prevent putting additional stress on the tendon, wearing footwear that provides good support is also recommended. Left unattended, Achilles tendonitis can become chronic and can cause pain when doing even the most basic of activities like walking, climbing stairs and squatting.

Calcaneal apophysitis (Sever’s disease)

Calcaneal apophysitis is considered the most common cause of heel pain among athletes aged 5 to 11. The condition is classified as an overuse injury caused by repetitive micro trauma while running or engaged in sports.

Sever’s disease is observed to be prevalent among soccer, basketball, and track athletes. Common symptoms of the condition often include tenderness and pain in the back and bottom of the heel. In some cases, swelling may also occur.

Treatment

Treatment for Sever’s disease include stretching of the calf muscles, pain medications like ibuprofen or acetaminophen, and icing. Cushioned heel lifts may also be used to help alleviate the pain.

In most cases, symptoms are resolved within two weeks and the child can resume playing sports within 3 to 6 weeks.

Fractures

Children who are engaged in high-impact sports are more prone to foot or heel fracture. While rare, heel fractures occur as a result of sudden impact or landing from height.

Telltale symptoms that indicate heel fracture include bruising, severe pain, and inability to bear weight on the affected foot. A Journal of Bone and Joint Surgery article reported that conservative management of heel fractures in children produces positive long-term results.

Treatment

Noninvasive treatment options for heel fracture include rest, immobilization (using a splint or a cast), ice, and pain medications. Participation in sports or strenuous activities should be avoided until the bone heals completely.

Physical therapy might also be suggested as it can help during and after the healing process.

Plantar fasciitis

The plantar fascia is a thick band of connective tissue. It runs along the underside of the arch of the heel to the front of the foot. When the plantar fascia is irritated secondary to overuse, a condition known as plantar fasciitis develops.

Plantar fasciitis can occur in all people regardless of age, including children. Symptoms of the condition can include walking difficulty, tightness or tenderness along the foot’s arch, and pain in the bottom of the foot. Symptoms are often bothersome in the mornings but can get better throughout the day. Akin to Achilles tendinitis, symptoms often start off as mild and gets worse over time.

Treatment

Treatment for plantar fasciitis includes compression, massage, ice, rest, and stretching of the calf muscles. When symptoms that point to the condition manifests, avoiding activities like jumping or running, extended periods of standing, and long walks are suggested.

To minimize inflammation, icing the area is recommended. Anti-inflammatory medications are also prescribed to combat pain.

In some cases, special orthotic shoes are suggested to help prevent reoccurrence. To help facilitate faster healing, rolling a tennis ball along the foot’s arch is done to help enhance circulation.

Figure-of-eight taping of the foot has also been known to help.

Wrap Up

To play safe, when a child experiences heel pain, a visit to a pediatric orthopaedic or foot and ankle specialist is recommended. While most heel conditions often respond to conservative measures, prolonged heel pain can be an indication of something more serious.

In most cases, pain that is unrelated to activity may be attributed to infection, tumor, and other congenital problems.

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