Updated: Aug 13, 2018
With spring fast approaching, children and adolescents are starting to become more active and are participating in outdoor activities, such as sports clubs and leagues, including track, soccer, and baseball. Unfortunately, this also means that athletic injuries will also increase.
In my experience, I have seen the most children in the clinic during the summer months. Sprains, broken bones, and lower extremity pains related to flatfoot deformity are not uncommon among the athletic and active youth. Yet, one of the most common foot-related complaints I have heard from kids (boys more than girls) is heel pain.
The heel pain in children is not the same as the heel pain in adults, though, so it is important to not get confused. While plantar fasciitis may be the most common cause for heel pain in adults, a condition called calcaneal apophysitis (aka Sever's disease) is a common cause for pain in children (and more specifically boys from ages 8-14) (1). (Disclaimer: There are several causes of heel pain in both children and adults, but for the sake of this blog, I will be referring to plantar fasciitis and calcaneal apophysitis). If are you unfamiliar with calcaneal apophysitis, continue reading below to learn what it is, how it differs from heel pain in adults with plantar fasciitis, and ways in which it is actually similar to plantar fasciitis.
Plantar fasciitis = Inflammation of the large ligament underneath the bottom of the foot.
This ligament starts at the heel bone, extends underneath the arch of the foot, and ends in the forefoot. It functions to help support the arch of the foot. When added stress is placed on the ligament (i.e. increase in higher impact activities, prolonged walking/standing, use of improper shoe gear, barefoot walking), it can become inflamed, tear, and cause pain. This is known as plantar fasciitis.
Calcaneal apophysitis = Inflammation of the growth plate region of the calcaneus (heel bone).
Open growth plates in children are weaker than bone, so injuries tend to happen in these regions. The heel bone is an attachment site for both the Achilles tendon and plantar fascial ligament. With higher impact activities, such as running, stress is placed on these soft tissue structures, which pull along the heel bone. This can irritate and cause inflammation around the growth plate region. This is known as calcaneal apophysitis.
In both plantar fasciitis and calcaneal apophysitis, pain is often noted with weight-bearing activities and is relieved with rest. With plantar fasciitis, pain may also be experienced with first steps after periods of rest. This is called post-static dyskinesia. Lastly, plantar fasciitis is not always felt in the heel. Because it is the ligament that is inflamed, one can experience pain anywhere along the course of the ligament, including within the arch of the foot.
Treatment is often the same for both conditions and is often aimed at resting the affected limb to allow it to heal. Below is a chart with the different treatment options for both conditions. As you can see, injections are usually saved for adults and a common device for calcaneal apophysitis is use of Tuli's heel cups (which is not listed under plantar fasciitis). One important thing to keep in mind is that symptoms associated with calcaneal apophysitis can continue to be problematic until the growth plate closes, sometime during the child's teenage years.
Disclaimer: The above information is meant for educational purposes only and should not be construed as medical advice. Please consult the doctor, or your own healthcare professional, should you have any questions or concerns related to your health.
1. Calcaneal Apophysitis (Sever’s Disease). ACFAS website. Retrieved from https://www.acfas.org/Content.aspx?id=1483