Heel pain in youth - calcaneal apophysitis or Sever's disease
05/19/2013
Heel pain is less common in children than adults and the causes are usually different. It is unusual for plantar fasciitis to occur in youth.
The most common cause of heel pain in the approximately 9 to 14 year old age group is calcaneal apophysitis or Sever's disease.
The heel bone or calcaneus has a growth plate, that is, an open area of growing tissue that creates bone growth located at the posterior (back) area where the Achilles tendon attaches. A growth plate is termed an "epiphysis" and a growth plate to which a tendon attaches is known as an "apophysis." Inflammation at the apophysis of the heel bone is called "calcaneal apophysitis."
An x-ray of the heel bone in a child shows two areas of bone, the main part of the heel bone and a portion in the back with "space" in between the two bones. That space gets smaller as the two bones grow toward each other. Eventually, the space between the two bones disappears and the two bones become one. That occurs between the ages of 13 to 15 although there is some variability.
The area between the "merging" heel bones or calcaneal apophysis appears most sensitive to overuse injury within 18 months to fusion, in my experience.
Most patients we see with calcaneal apophysitis present with certain factors in common:
1) They are active in school sports; often soccer, basketball or football.
2) A tight heel cord or Achilles tendon is frequently present.
3) They often display subtalar joint overpronation, that is, the foot/heel/arch tends to roll in excessively when walking and standing.
The popularity of school soccer has led to an increase in cases of calcaneal apophysitis in my practice. Soccer shoes provide little protection for the heel and little support.
Here are some potential treatments to try before seeing a pediatric podiatrist:
1) Stretching of the Achilles tendon. Should be done gently, especially if pain is present.
2) Use running shoes in lieu of soccer and basketball shoes when possible, that is, when not playing the game or in practice.
3) Consider a good OTC insert such as Powersteps or Superfeet.
4) Rest, icing and use good judgement. Playing through pain can lead to further injury.
Seek professional treatment if self care is not effective. The key issue is to identify the causes of the heel pain and target treatment to alleviate the causes. If there is excessive Achilles tightness or contracture then a course of manual therapy can be effective. Significant overpronation is treated with a prescription orthotic. We general use an orthotic design which has a deep heel cup. The heel cup is the portion of the orthotic that surrounds the heel. The orthotic may have a rearfoot post which is a wedge that stabilizes the heel, neutralizing excessive motion and stress on the growth plate.
For more information on pediatric foot problems, visit: Childrens Foot Doctor San Antonio
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