Kids tend to get aches and pains everywhere as they grow, and the heels are a very common area for these pains to occur.
Children aged between 8 and 14 years old who are active may complain of heel pain, which might be what we call Calcaneal Apophysitis, otherwise known as Sever’s Disease.
What is Sever’s Disease and Why Does it Happen?
At the back of the heel, there is a growth plate which can become irritated and inflamed.
This can cause an aching pain primarily through the heel. They may also complain of pain, tiredness or aching in their calves and under their feet through the plantar fascia.
The calf muscles attach onto the back of the heel via the achilles tendon, right near where the growth plate is.
Often, children will avoid heel contact when walking or walk with a limp, favouring the sore heel.
It can be a very painful condition and can affect your child’s ability to play their favourite sports.
What Causes Sever’s Disease?
Calcaneal Apophysitis can occur due to:
- Growth spurts, particularly of the bones within the lower leg (tibia and fibular).
- Growth of the muscles in the lower leg and around the heel to keep up with bone growth.
- Poor footwear that does not support the feet appropriately.
- Traction of the achilles tendon against the heel bone (calcaneus).
- Participation in high impact sports such as athletics, netball, basketball, football and so on.
Who Should I See for Help with Calcaneal Apophysitis?
If your child is aged 8-14, is sporty and is complaining of heel pain, it is best to see a podiatrist to see how their pain can be treated.
The main test that we perform when children see us with heel pain is a squeeze test.
The heel is cupped and squeezed and if the child experiences pain, it is likely that it is calcaneal apophysitis.
We also perform a range of tests in order to assess:
- The range of motion within your foot and ankle.
- The flexibility of your calves.
- The strength of the muscles that run from the lower leg into the feet.
- Your walking and running patterns.
What are the Sever’s Disease Treatment Options?
It is important to note that this is a condition that will get better with time!
Treatment options are relatively straightforward and need to be followed closely in order to help reduce the inflammation. We will work with your child to create a customised treatment plan for them based on our thorough assessment.
We know it’s very hard to ask active kids to stop being active, because who didn’t love running and jumping around the playground as a kid?
There are a number of ways to help reduce the pain, such as:
- Icing the area – Fill a polystyrene cup with water and freeze it. Peel back the edges of the polystyrene and use the icy tip to massage around the heel, moving up the achilles tendon at the back of the ankle and making sure you cover the entire heel. You can also use a simple ice pack. This will help with decreasing inflammation at the heel.
- Heel lifts – These are small devices that can be fitted into your shoes to help elevate the heels, which takes pressure off of the growth plate and achilles tendon insertion. These can be worn in most closed in shoes.
- Calf stretches – As mentioned before, sometimes children with heel pain will have tight calves. Therefore, stretching the calves can reduce the traction on the back of the heel and take some of the pressure off the achilles and calf muscles.
- Strengthening of the calves– This will help to decrease the pressure placed on the heel and the plantar fascia and increase the strength of the achilles. Exercises can include single and double leg calf raises or theraband exercises.
- Massage – Massaging through the calf muscles, the plantar fascia and the heel can help to relieve pain. This helps to relax the muscles and increase blood flow to the area to help with healing.
- Activity modification – Kids don’t just stop running and being active, even when they’re in pain. However, their level of activity needs to be modified in order for the inflammation to decrease and this is crucial. This can be done by reducing 2 training sessions down to 1, or playing half a game instead of a full game until the pain is more manageable.
- Footwear modification – Ensuring that your child is in supportive footwear is exceptionally important. Shoes that are flat, too flexible and either too big or too small are not ideal in the growing and active child and place more stress on the feet and legs. Bring the shoes into your appointment so that we can assess them and make suggestions on which shoes would be more appropriate.
- Orthotics – Orthotics may help to move pressure away from the heel and support other structures in the feet as well. These can be either prefabricated or custom orthotics depending on the child’s foot posture and function. To learn more about orthotics read our guide to orthotics here.
Our team of highly trained podiatrist’s are experts in Children’s Podiatry, so if your child is suffering from heel pain, contact us here at Watsonia Podiatry on (03) 9432 2689, or alternatively you can book online here.