Heel pain is common in kids. Although it’s typically not serious, proper diagnosis and prompt treatment is recommended. If your child comes to you with complaints of heel pain, tenderness in the back of the foot or ankle, or is limping or walking on their toes, they may have an injury such as Achilles tendonitis or Sever’s disease.
Heel and foot injuries can develop gradually over time and are usually the result of overuse. Many children are involved in competitive sports with rigorous training schedules. Overuse injuries are common but usually resolve with rest and conservative measures. Treatment is important, as ignoring symptoms can lead to more severe injury and chronic pain.
Here are a few different causes of heel pain and how you can help your child heal.
Calcaneal apophysitis (Sever’s disease)
American Family Physician identifies calcaneal apophysitis as the most common cause of heel pain in athletes ages 5 to 11.
It’s an overuse injury caused by repetitive micro trauma during sports or running activities. It’s thought to be due to the pull of the Achilles tendon on the growing heel bone. Causes include running or jumping, and it’s usually seen in basketball, soccer, and track athletes. Young girls who jump rope are also at risk for calcaneal apophysitis. Symptoms include pain in the back of the heel and tenderness when squeezing the back of the foot. Warmth and swelling may also occur.
Treatment includes icing, stretching of the calf muscles, and pain medications like acetaminophen or ibuprofen. Cushioned heel lifts may be used temporarily to help relieve pain. Symptoms usually resolve within a couple of weeks and the child can return to sports within three to six weeks.
Achilles tendonitis can occur in children, often after a sudden increase in activity.
It may be identified a few weeks into a new sports season, and symptoms include pain in the heel or the back of the foot. The Achilles tendon attaches the two muscles of the calf to the heel bone and helps push the foot forward during walking or running.
When inflamed, it can cause pain, swelling, warmth, and difficulty walking. Pain may start off mild and gradually get worse. Children who do repetitive activities like running, jumping, or pivoting, like basketball players and dancers, may develop Achilles tendonitis.
Treatment includes rest, ice, compression, and elevation. Using an elastic wrap or tape to keep swelling down and support the tendon during the initial inflammatory period may help.
Anti-inflammatory medications like ibuprofen can help decrease pain and swelling. Stretching exercises for the ankle and calf muscles may also aid in recovery and help minimize re-injury.
It’s important for your child to wear proper shoes with good support to prevent undue stress on the tendon. Early treatment and avoiding aggravating activities is best until the pain fully resolves. Without treatment, Achilles tendonitis can turn into a chronic condition and continue to cause pain during daily activities such as walking.
Plantar fasciitis is an overuse injury that involves irritation of the plantar fascia, the thick band of connective tissue that runs along the arch from the heel to the front of the foot.
It can occur in people of all ages, including children. Symptoms include pain in the bottom of the foot close to the heel, difficulty walking, and tenderness or tightness along the arch of the foot. It’s usually worse in the morning and gets better throughout the day.
Similar to Achilles tendonitis, symptoms usually start off mild and get worse over time. Risk factors include a sudden increase in activity, sports that involve running or jumping, wearing shoes that are worn out or have poor support, and activities that involve a lot of standing.
Treatment includes rest, ice, compression, massage, and elevation. When symptoms appear, children should avoid doing activities like running or jumping and refrain from long walks and extended periods of standing.
Icing the area will help decrease inflammation, and anti-inflammatory medication can help reduce pain. Rolling a tennis ball along the arch of the foot can help massage the area and increase circulation, leading to faster healing. Sometimes, special orthotic shoes are recommended to prevent reoccurrence. Figure-of-eight taping of the foot may also help.
Children who play hard or engage in high-impact sports may also be at risk of a heel or foot fracture. Although rare, heel fractures can occur after a fall or sudden impact.
Symptoms include severe pain, swelling, bruising, and inability to put weight on the affected foot. An article in the Journal of Bone and Joint Surgery that investigated the long-term effects of heel fractures in children reported that conservative management of almost all forms of heel fractures in children leads to positive long-term results.
Conservative treatment includes ice, rest, immobilization with use of a cast or splint, and pain medications. Children should avoid participation in activities or sports until the bone is completely healed.
Physical therapy can help during and after the healing process and assist in a gradual return to activity. It’s important to be evaluated by a medical professional to determine if it’s a fracture or if the pain is due to another cause that requires different treatment.
Complex fractures may require surgery, but this is rarely the case in children.
Always consult a physician regarding your child’s heel pain. Although most heel pain resolves with conservative measures like rest, ice, compression, and elevation, prolonged heel pain can indicate something more serious. Pain unrelated to activity may be caused by tumors, infection, or congenital problems. Encourage your child to take the following preventive measures to prevent heel pain:
- always wear proper shoes
- never skip warmup or cool down exercises
- engage in stretching and strengthening exercises for the calves
- stay in shape all year long to prevent overuse injury at the beginning of a sports season
After a proper evaluation from a professional, heel pain can be easily treated at home.
As children grow, they may encounter various pains and strains. It’s your job as a parent to encourage rest, healing, and recovery. Although sports and physical activity have many positive benefits, injuries can occur. Playing through the pain is not always the best solution when it comes to heel injuries.