Children's Heel Pain


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The heel bone or calcaneus is one bone in an adult but forms from two bones during development.  The main part of the heel bone and the area of the heel bone to which the Achilles tendon attached to are the two parts.  A growth plate of softer cartilage-like tissue separates the two parts.  A growth plate is termed an "epiphysis" and a growth plate to which a tendon attaches to, an apophysis.  So "calcaneal apophysitis" means inflammation of the growth plate in the heel bone.  "Sever's disease" is another term for calcaneal apophysitis.
The calcaneal apophysis gradually disappears as the two parts of the heel bone fuse to become one bone, a process that may occur between the ages of 10 and 14 years of age. The calcaneal apophysis is most sensitive to trauma and most likely to cause pain when over-stressed about 18 to 24 months prior to the time of fusion. 
Factors that can stress the calcaneal apophysis include sports that involve a lot of lateral motion such as soccer and basketball, overpronation or inward rolling of the foot, overweight and shoes with inadequate protection for the heel bone.  Soccer shoes, for the most part, are not designed for the immature heel bone, and are often a culprit.


Symptoms of Sever's disease or calcaneal apophysitis may include:

  • Pain in the back or bottom of the heel, often after activity
  • Limping
  • Walking on toes
  • Difficulty running, jumping, or participating in usual activities or sports
  • Pain when the sides of the heel are squeezed

Sports such as soccer and basketball may aggravate the symptoms.

Children rarely develop plantar fasciitis. Children in the age group from about ages 9 to 13 may have a unique type of heel pain related to the fact that the growth plate in their heels is still open and is moving toward being closed. The child's heel is made up of two areas of bone (ossification centers); one in the body of the heel bone and one in the area beneath the achilles tendon. The area in between the two parts of the heel bone is called a growth plate. The area of bone in the back of the heel bone, immediately behind the growth plate is called the calcaneal apophysis. Calcaneus means heel bone.
The achillles tendon attaches to the area of bone right in back of the heel bone and that area is called the calcaneal apophysis. An apophysis is an area of growing bone adjacent to a growth plate, to which a tendon attaches. When that area becomes inflamed or painful, it is known as calcaneal apophysitis.

Eventually the heel bone becomes one bone so if the area is inflamed, the condition will go away once the apophysis no longer exists. The years while the growth plate is open and while calcaneal apophysitis is raging can be quite painful. This problem has become more common than in prior generations in part due to the popularity of soccer as soccer shoes tend to place a lot of strain on the area.

Luckily, this is a problem that has a cure that is better than 99 percent effective. The cure involves the fabrication of a specialized orthotic made from a model of the foot. The orthotic is very deep in the heel area and conforms very closely to the contours of the foot. The goal is to create a device that minimizes motion in between the two pieces of bone. Placing soft pads in the area can provide some temporary relief but often aggravate the problem since the soft surface actually can increase motion between the two bones.

Treatment of calcaneal apophysitis is targeted at eliminating the cause of the problem:
1) Shoes: excessive pronation of the foot may be helped by shoes with proper support, either motion control shoes or stability shoes depending on the level of control required.  Occasionally, it is necessary to modify the soccer shoe by placing a wedge in between the outsole and midsole of the shoe that does not let the heel drop backwards too much but is an easy modification to do in the foot specialist's office.

2) Orthotics: the term "orthotic" or "foot orthotic" is sometimes used loosely but a true orthotic is a therapeutic device designed to improve function of the foot. Many store bought "orthotics" are little more than cushions or arch supports. The pediatric podiatrist may choose to utilize a high quality prefabricated orthotic, a prefabricated orthotic that is modified or a prescription (custom made) orthotic. 

3) Rest: rest is effective in improving symptoms in the short run but not usually a long term solution. 

4) Physical therapy: a tight heel cord can be a factor in calcaneal apophysitis. Manual therapy is a type of physical therapy that can be very effective for this.

 Dr. Ed Davis specializes in Pediatric Podiatry in San Antonio.
For more information on Children's Heel Pain and other Children's Foot Problems in the San Antonio, TX area, call Ed Davis, DPM, FACFAS. at (210) 490-3668 today!

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South Texas Podiatrist
109 Gallery Circle, Suite 119
Stone Oak

San Antonio, TX 78258
Phone: 210-490-3668
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