Thursday, September 24, 2009

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.

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