Heel pain among kids

Heel pain among kids
I had a friend ask me yesterday about heel pain in her 11 year old son. He plays football, and has had pain for the last few weeks. It is becoming more severe, and is affecting his ability to play sports. Her question was what could be causing his pain, and if she should take him to the doctor for treatment. Obviously, it is not always possible to make a diagnosis without seeing the patient. In this case, though, in the absence of an injury, a diagnosis of Sever's disease (or calcaneal apophysitis) is the most likely cause of his symptoms.

Unlike classic plantar fasciitis, this condition occurs in the growth plate in the back of the calcaneus, or heel bone in pre-teen kids. It is most common in those who are very active in sports, and boys are affected more often than girls. Those who are overweight are also more prone to develop this condition.

Treatment consists of decreasing the inflammation in the area by the use of ice and anti-inflammatory medications. Also helpful is the use of a heel lift in the shoe. By raising the heel 1/4" to 3/8", the forces exerted on the growth plate by the achilles tendon are decreased. Stretching of the achilles tendon is also helpful. Finally, decreasing athletic activities is often needed to help resolve the symptoms. In the long run, this is a problem that will go away once the growth plate closes as the bone reaches maturity. For most children, this is at about at age 16. However, in the short term, treatment is important in order to allow patients to return to their preferred activities as soon as possible. Following resolution of the problem, prevention is important to avoid recurrence of symptoms. This includes the continued use of a heel lift. In some instances, taping of the foot or the fabrication of functional foot orthotics (see http://www.concordfootdr.com/orthotics.html) will help prevent the return of this painful condition.

Orthotics as a treatment for heel pain (plantar fasciitis)

In my opinion, treatment for plantar fasciitis almost always includes the dispensing of functional foot orthotics. The cause of plantar fasciitis is the overstretching of the plantar fascia which leads to inflammation and pain. Orthotics are useful in that they help to relieve excessive stretching of the plantar fascia, and thereby can not only be used to treat the symptoms of heel pain, but also help to eliminate what is causing the problem.

Orthotics are often confused with arch supports, but there are significant differences. Although they may look similar, orthotics are custom made from an impression of the foot. There are a variety of ways to take the foot impression, including the use of plaster casting material, foam, and digital scanning. Each method has its advantages and disadvantages.

Plaster casting is the oldest method, and is still widely used today because it provides an excellent representation of the contours of the foot. It also has the advantage that if done properly, the foot can be held in a neutral position. What this means is the doctor has the ability to place your foot in the position that he or she would like it to function in while you're standing or walking. This, I believe, will give you the best chance of receiving orthotics that are comfortable to wear, and also be effective in relieving your symptoms. Plaster casting does take more time, and is messy, but I have found that it works best for me in my office.

Foam is also used to take foot impressions. Your foot is placed in the foam, and you end up with an instant impression of your foot without the mess of plaster. The disadvantage is that the doctor has much less control of the placement of your foot while the impression is being obtained, leading to less reliable orthotics.

Digital scanners are a relatively new method of obtaining a foot impression which allow the doctor to control the position of the foot during the procedure. It is fast, clean and easy to do. Once the image is obtained, it can be sent to the lab electronicaly to begin the process of fabrication immediately. This leads to you get your orthotics sooner. The downside to the use of optical scanners is the cost of the equipment, which has kept it from being implemented in more offices.

There is one final method that is used to obtain an impression of the foot that uses a pressure plate to estimate the contour of the foot. Using these devices is very quick, and like with the optical scanners, the order can be sent electronically to the lab. However, it is impossible for a pressure mat to get an exact contour of the foot, so in my opinion, orthotics made using this method of obtaining foot impressions lead to less than optimal orthotics. I do not consider such devices to be custom or functional.

Once you receive your orthotics from the lab, you may experience a period of time of adjustment to get used to wearing them. It is not uncommon for minor adjustments to be made. These can usually be made in the office. Most labs allow 90 days for adjustments to be made without additional charges, so if there is a problem with your orthotics, make sure you let your doctor aware of the problem within the first 90 days after receiving them.

Patients are sometimes surprised to learn the cost of functional foot orthotics. While they are expensive to make, most will last for years, and if the pain is resolved with the use of orthotics, I'm certain you will find that money was well spent.