AllHeel pain is a common complaint in adults. Heel pain can also occur in childhood but it is typically produced by a different mechanism. As children go through “growth spurts” between the age of 11 and 14, the muscles and tendons in their legs can become tight as they try to keep up with the rapid growth in the long bones. Heel pain in children typically is the result of a tight Achilles tendon. In children, there is a thin irregular shaped band of cartilage in the back portion of the heel bone called a growth plate (see x-ray image below). As the name implies, new bone forms within a growth plate, which is also found in other bones in the feet, legs, hands and arms. As a child goes through a "growth spurt," the rapidly elongating leg bones stretch the Achilles tendon which in turn pulls tighter on its insertion into the heel bone. A tight tendon is usually not a problem. However, when a child is very active in sports, such as soccer, or basketball, the increased activity creates further tightening of the tendon. The result is a traction or pulling force which is absorbed into the heel bone (see illustration, below). As cartilage is softer than bone, the growth plate frequently becomes irritated and painful as the traction force increases. This process is more commonly seen between the age of 8 and 13 years old. On examination, one can reproduce pain by pressing both under the heel as well as compressing the heel bone (calcaneus) from side to side. Other causes of heel pain include a fracture or bone tumor, so x-rays are usually performed in evaluating this condition. Treatment includes rest, ice and anti-inflammatory medication. An arch support and heel lift are both helpful. For severe cases, a non-weight bearing splint or cast may be applied. Long term treatment usually includes use of functional orthotics. The problem is self-limiting and goes away after the growth plate closes, around the age of 13 to 14 years old. - Seth Rubenstein, DPM Dr. Rubenstein practices in the Reston (703-391-0211) location. The information on this site is provided for your assistance only; this site does not provide podiatric advice. You should never diagnose or treat yourself for a podiatric condition based on the information provided herein, and the information is not provided for that purpose. Likewise, you should never determine that treatment is unnecessary based on this information. The information contained herein is not a substitute for podiatric care provided by a licensed podiatric professional. The information provided herein is not podiatric, medical or professional advice. This site does not create a doctor-patient relationship. Doctor Rubenstein and Foot and Ankle Specialists of the Mid-Atlantic, LLC expressly disclaims all warranties of any kind, whether express or implied, related to any products offered for sale on this web site. Doctor Rubenstein and Foot and Ankle Specialists of the Mid-Atlantic, LLC further expressly disclaims any product warranties of effectiveness or fitness for any particular purpose or use. You are solely responsible for your use of, or reliance on, any products offered for sale herein, and any consequences arising out of such use or reliance. In no event will Doctor Rubenstein and Foot and Ankle Specialists of the Mid-Atlantic, LLC be liable for any damages resulting from use of or reliance on any such products, whether based on warranty, contract, tort or any other legal theory. This Website, and the information contained herein, is provided to you as a service for use at your sole risk. If you are feeling ill, please call your primary care physician, or other healthcare provider. In the case of an emergency, please go to the nearest hospital. Spring is upon us, and choices of shoe gear change, as well as increased levels of outdoor weight-bearing activities, which can set us up for sesamoid injuries of the great toe joint. Sesamoid injuries are common, but often overlooked injuries to the great toe joint. Proper diagnosis and early treatment intervention is essential. Most people experience pain in their underlying great toe joint made worse with weight-bearing activity. So what exactly are sesamoids? Sesamoids are accessory bones found throughout the body. They are found embedded in tendons and act as pulleys to increase the power and efficiency of those tendons and their neighboring joints. The kneecap is the largest sesamoid bone in the body and increases the strength of the quadriceps tendon during knee extension, enabling us to walk, jump and climb with greater power. In the foot, there are two sesamoid bones present in the flexor tendon beneath the great toe joint. They are about the size and shape of peanuts. Their job is provide us with greater propulsion when walking, running and jumping. Certain activities and biomechanical factors can contribute to sesamoid injuries.
- High arches place more force on the heels and sesamoid bones.
- Bunions change the weight bearing distribution on the sesamoid bones.
- High heeled shoes.
- Sports such as running, basketball, ballet, football and tennis.
- Sesamoiditis: This is an overuse injury of the sesamoid bones, caused by a repetitive bruising of the bones. The symptoms will quickly improve if the pressures on the sesamoids can be reduced.
- Fracture: The fracture is often from a memorable event, but sometimes can result from prolonged overuse. Unlike most bones, the sesamoid bones of the foot have poor blood supply leading to prolonging or non-healing.
- Avascular necrosis: Blood supply to the sesamoid bone is lost leading to degeneration and chronic pain.
- Turf toe: This is an acute hyperextension injury of the great toe joint seen in high energy sports such as football. The ligaments and tendons around the sesamoids are strained.
Treatment Without SurgeryBunions are structural deformities, meaning they are caused by shifting of bones. Unfortunately, they are permanent and no conservative treatment will remove the bunion. Only surgery can permanently correct the bunion. However, there is some treatment to make you more comfortable and decrease the progression of the bunion. These are some of the conservative measures I use to treat my patients with bunions:
- Wear proper fitting and comfortable shoes with less than 2 inch heels and provide plenty of space for your toes and forefoot. Have your feet professionally measured
- Protect the bunion with a moleskin or gel-filled pad
- Use toe spacers between the 1st and 2nd toes
- Use orthotics to help position the foot and redistribute weight correctly
- Night splint to hold the toe straight, stretch the soft tissue and ease discomfort
- Steroid injections into the joint
- Use warm soaks, ice packs, Whirlpool, ultrasound and massage
- Maintain a proper weight