Pediatric Heel Pain Causes and Treatment.

What Is Pediatric Heel Pain?
Heel pain is a common childhood complaint. That doesn't mean, however, that it should be ignored, or that parents should wait to see if it will "go away." 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.

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 physis), 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 podiatric foot and ankle surgeon is best qualified to determine the underlying cause of the pain and develop an effective treatment plan. Conditions that cause pediatric heel pain include:

• Calcaneal apophysitis.
• Tendo-Achilles bursitis.
• Overuse syndromes.
• Fractures.
Diagnosis of Pediatric Heel Pain

To diagnose the underlying cause of your child's heel pain, the podiatric 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. For mild heel pain, treatment options include:

- Reduce activity.
- Cushion the heel.

For moderate heel pain, in addition to reducing activity and cushioning the heel, the podiatric surgeon may use one or more of these treatment options:
• Medications.
• Physical therapy.
• Orthotic devices.
• Immobilization.
• Follow-up measures.
• Surgery.

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 podiatric surgeon.