Every so often, more so in the summertime, I have a parent bring their active child into my office complaining of heel pain. These children generally fit the following criteria:
1: Ages 9 - 14.
2: More males than females.
3: Large frame or slightly overweight.
4: Involved in a sporting activity requiring cleats (more specifically soccer).
5: Nothing seems to relieve the pain.
I palpate the back of the heel and will elicit pain at a level of 7 to 9 out of the 10 scale. X-rays of the foot will reveal a separation of bone towards the back which is normal and is not a fracture. This is an open growth plate which indicates the child has not reached skeletal maturity at least of the foot and ankle. (It also means you will still be buying new shoes about every year).
This condition is what we medically refer to as apophositis or Severs disease. This is a very treatable condition with the most important aspect of this treatment being time. The child will need to stop the 'offending' activity and shoes for about 2 to 3 weeks. Icing of the heel 2 to 3 times a day with a sock on for approximately 15 minutes helps reduce the inflammation. Wearing an open back shoe or using a heel lift takes pressure off the back of the heel. In extremely painful situations, I will put the child in a CAM (Controlled Ankle Motion) walking boot and oral anti-inflammatories medications for a week to ten days.
As a special note, I am uncomfortable when Pediatricians, whom I respect, attribute pain in the foot and ankle as "growing pains." Discomfort (pain at a level of less then 3 out of 10) is somewhat normal for a child in the age range I mentioned above. However, pain at a level starting at 5 or above is not normal and you should take your child to visit your local Podiatrist.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
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