Pediatric Heel Pain
What is most likely causing your child’s heel pain?
Children's heel pain and adult heel pain are not the same and are not treated the same
The Most Common Causes of Heel Pain in Kids
Heel pain in children is not uncommon and can be caused by a few different issues. However, it is most likely due to achilles tendinitis, a heel fracture, JIA, Tendo-Achilles bursitis, or Sever’s disease.
The most common cause of children’s heel pain between these is Sever’s disease. This overuse injury occurs most often in athletic children ages 7 to 15, but may occur as young as 5.
(We find that parents often dismiss a child’s heel pain as a normal part of growth. It is not. And, even though most heel pain is not a sign of something more serious, it should be evaluated by a pediatric podiatrist.)
Did you know...?
1. 90% of the children seen for heel pain here at Pediatric Foot & Ankle is caused by Sever’s Disease.
2. The most common misdiagnosis for children’s heel pain is plantar fasciitis. Most of all of these cases prove to be Sever’s.
(Pediatric Foot & Ankle sees and treats dozens of children every month for heel pain, and in the past 9 years have had only one case of pediatric plantar fasciitis. The child was 16 year old and was successfully treated. So, it’s not impossible for children to get plantar fasciitis, but highly ulikely and very uncommon.)
3. The second most common cause of heel pain in children is achilles tendinitis.
4. A less common, but not unheard of cause of children’s heel pain, is juvenile idiopathic arthritis, formerly known as juvenile rheumatoid arthritis.
5. A pediatric podiatrist is the most qualified professional to diagnose and treat children’s heel pain and determine the best after care and prevention plan too.
The Most Common Cause of Children's Heel Pain
Sever's Disease (Calcaneal Apophysitis)
Sever’s disease, also known as calcaneal apophysitis, stems from a rapid growth spurt. It is caused by the heel bone growing at an accelerated rate and becomes inflamed due to sudden stretching of surrounding muscles and tendons that have not yet adapted to this change in pressure.
Girls generally experience this growth spurt between 7 – 13 years old while boys will experience them around 10 – 15 years of age. Of course, this will depend on the individual children’s development rates.
Dr. Jarman's 2 Part Series on Sever's disease (7 minutes total)
Diagnosing Sever's disease
In this fist video of a two part series, Dr. Jarman shows how to identify whether or not your child’s heel pain might be Sever’s disease.
Treating Sever's disease
In this video, Dr. Jarman discusses the different treatment options for Sever’s and which option would be best for your child.
Symptoms & Diagnosis
Pain is generally felt at the back and either inner or outer side of the child’s heel, but sometimes on the bottom too. The pain will relieve when the child is not active but becomes painful with sports, especially “ground and pound” activities. Squeezing the sides of the heel bone will produce sharp or burning pain. Sever’s can affect one or both heels, and in severe cases the child will be limping.
Diagnosing Sever's disease
Dr. Jarman begins by taking the child’s medical history, paying special attention to activities they participate in, such as sports played. The physical exam includes gently squeezing the sides of the heel and having the child stand flat and then on tip-toe. Pain felt during any of these tests may indicate Sever’s disease, but further tests are done before just jumping to that conclusion.
The most definitive test is x-rays which are taken in office to rule out the possibility of foot fractures. High quality digital x-rays are taken in office and reviewed and shared during the first visit.
Treating Sever's Disease
Acute or Chronic?
Treatment depends on whether your child has acute or chronic Sever’s disease.
Acute treatment begins with resting the foot by reducing activities for one week. In many cases this is all that is needed, and the the child can resume activities starting off slow and working their way back up to full activities. Dr. Jarman may also recommend over-the-counter anti-inflammatory medications (i.e. ibuprofen). He will likely suggest a change in shoe gear as well which could include a reputable over-the-counter gel heel cup which he will help pick out based on your child specifically.
If acute care fails, Dr. Jarman begins treatment for chronic Sever’s disease. This includes correcting your child’s gait (how the foot hits the ground) and a custom orthotic to relieve pressure on the growth plate and stop the pain. In extreme cases, your child may require a CAM boot (Controlled Ankle Motion boot) to completely immobilize the foot for two to three weeks.
Pediatric Foot & Ankle has been treating Sever’s disease in children for nine plus years and has found that the most effective solution is a pair of custom-fit orthotics and a pediatric nihttime brace.
Dr. Jarman prescribes this Sever’s treatment combination, and has consistently achieved total resolution of the child’s Sever’s disease in every case where Sever’s was the only heel pain cause.
The Mikki Device™ is a Sever’s solution based of off Dr. Jarman’s treatment protocol and is now available to parents and podiatrists across the world.
Sever's Disease Custom Orthotic
The Mikki Device™
The Mikki Device™ is a custom orthotic shoe insert designed with the help of a pediatric podiatrist. Even when other Sever’s treatment options have failed, the Mikki Device™ has proven effective in over 95% of the children who have used it.
Real Life Experiences Shared by Patients and Parents
Gracie's experience with Severs
Ryan's experience with Severs
Other Causes of Heel Pain in Children
Other causes of pediatric heel pain include Achilles tendinitis and fracture.
Achilles tendinitis occurs when the tendon connecting the calf to the heel (the Achilles tendon) becomes inflamed. This typically happens after a sudden increase in activity, such as beginning a new sport. Achilles tendonitis treatment includes resting and elevating the foot as well as ice to relieve swelling. Dr. Jarman may also prescribe wrapping the foot to help support the Achilles tendon during activities.
Heel fractures and foot fractures may occur due to acute injury or repeated stress. They’re most common in children who play high-impact sports. Conservative treatment includes immobilizing the foot, rest, and medication to manage pain. Dr. Jarman may also prescribe physical therapy to return full function to the foot.
Juvenile Idiopathic Arthritis (JIA) is the most common type of arthritis in children and teens. It can cause joint pain and inflammation in the hands, writsts, elbows, and even knees and feet. JIA used to be called “juvenile arthritis” but the term wasn’t accurate since JIA is not a kid version of adult rheumatoid arthritis.