Heel Pain in Children/Calcaneal Apophysitis

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What is Pediatric Heel Pain?
Heel pain is a symptom, not a disease. In other words, heel pain is a warning sign that a child has a condition that deserves attention.Heel pain problems in children are often associated with these signs and symptoms:

  • Pain in the back or bottom of the heel
  • Limping
  • Walking on toes
  • Difficulty participating in usual activities or sports

The most common cause of pediatric heel pain is a disorder called calcaneal apophysitis (see below), which usually affects 8- to 14-year olds. However, pediatric heel pain may be the sign of many other problems, and can occur at younger or older ages.

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What is the Difference between Pediatric and Adult Heel Pain?
Pediatric heel pain differs from the most common form of heel pain experienced by adults (plantar fasciitis) in the way pain occurs. Plantar fascia pain is intense when getting out of bed in the morning or after sitting for long periods, and then it subsides after walking around a bit. Pediatric heel pain usually doesn't improve in this manner. In fact, walking around typically makes the pain worse.

Heel pain is so common in children because of the very nature of their growing feet. In children, the heel bone (the calcaneus) is not yet fully developed until age 14 or older. Until then, new bone is forming at the growth plate (the apophysis), a weak area located at the back of the heel. Too much stress on the growth plate is the most common cause of pediatric heel pain.

Causes of Pediatric Heel Pain:
There are a number of possible causes for a child's heel pain. Because diagnosis can be challenging, a foot and ankle surgeon is best qualified to determine the underlying cause of the pain and develop an effective treatment plan.

Diagnosis of Pediatric Heel Pain
To diagnose the underlying cause of your child's heel pain, the foot and ankle surgeon will first obtain a thorough medical history and ask questions about recent activities. The surgeon will also examine the child's foot and leg. X-rays are often used to evaluate the condition, and in some cases the surgeon will order a bone scan, a magnetic resonance imaging (MRI) study, or a computerized tomography (CT or CAT) scan. Laboratory testing may also be ordered to help diagnose other less prevalent causes of pediatric heel pain.

Treatment Options:
The treatment selected depends upon the diagnosis and the severity of the pain.

Can Pediatric Heel Pain be Prevented?
The chances of a child developing heel pain can be reduced by following these recommendations:

  • Avoid obesity
  • Choose well-constructed, supportive shoes that are appropriate for the child's activity
  • Avoid, or limit, wearing cleated athletic shoes
  • Avoid activity beyond a child's ability

If Symptoms Return:

Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of the initially diagnosed condition, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.

Disclaimer: The advice on this website is not intended to substitute for a visit to your health care provider. We will not be held liable for any diagnosis made or treatment recommended. Consult your doctor if you feel you have a medical problem.

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