Heel Pain in Children

Heel 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.

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