Pediatric Heel Pain

Pediatric Heel pain is a common complaint in children. It is often associated with these signs and symptoms:

• Constant or recurring pain in the back or bottom of the heel

• Limping

• Walking on toes

• Difficulties during usual activities or sports

Pediatric heel pain is different from the common form of heel pain experienced by adults (plantar fasciitis). Plantar fascia pain is intense while getting out of bed in the morning or sitting for a long time, and then subsides after walking around for some time. Pediatric heel pain however, does not mitigate in this manner. In fact, walking around typically makes the condition worse. This is because, in children the heel bone (the calcaneus) does not develop until the age of 14 or more. Till that time a new bone develops at the growth plate (the physis), a weak area located at the back of the heel. Too much stress on the growth plate results in  pediatric heel pain.

CAUSES

Calcaneal Apophysitis: This is a condition caused by the inflammation of heel's growth plate due to muscle strain and repetitive stress. It usually causes pain and tenderness at the bottom of the heel while walking and pain is felt on the heel when touched.

Tendo-Achilles Burtis: This is an inflammation of the fluid-filled sac (bursa) located between the Achilles tendon (heel cord) and the heel bone. This is caused by injuries to the heel, certain diseases such as; juvenile rhemuatoid arthritis or by wearing poorly cushioned shoes.

Fractures: In some cases, heel pain results due to an injury in the bone. Hair line fractures resulting from repeated stress on the bone, often occur in adolescents engaged in athletic activities. In children under the age of 10, acute fractures can result from simply jumping from a couch or stairway.

DIAGNOSIS

To diagnose the actual cause of Pediatric heel pain, the doctor first reads a thorough medical history and asks questions about recent activities. X Rays are also used to evaluate the condition and in some cases the bone scan, a magnetic resonance imaging (MRI) study or CT scan may also be recommended.

TREATMENT

Pediatric heel pain can be treated in many ways. Some of the common treatment methods are:

• Medications: Non steroidal anti- inflammatory drugs such as ibuprofen are often advised to mitigate pain.

• Cushion the heel: Temporary shoe inserts are effective in softening the impact on the heel while walking, running and standing.

• Physical Therapy: Stretching or physical therapy modalities are also recommended to promote healing of the inflamed tissue.

• Immobilization: The use of crutches may be advised to avoid all weight-bearing on the affected foot for a while.

• Surgery: In some extreme cases, surgery may be required to lengthen the tendon or rectify other muscle problems.

PREVENTION

The possibility of a child developing heel pain could be reduced by observing simple rules. These entail:

• Prevention of obesity.

• Choosing well designed shoes will help treat the condition, supportive shoes that are conducive to child's daily activities.

• Avoiding activity beyond a child's ability.