Heel pain is less common in children than adults. Of those children who do get heel pain, by far the most common cause is an irritation to the growing area at the back of the heel bone (the Calcaneus) where the strong Achilles tendon attaches to it. This is known as Sever’s disease or calcaneal apophysitis (inflammation of the growth plate). It is most common between the ages of 10 to 14 years of age.
Anatomy of heel pain in the child
When a baby is born, most of the bones are still cartilage with only some starting to develop into bone. When the heel (calcaneus) starts to develop bone, there is generally one large area of development that starts in the centre of the cartilage heel. This area of bone spreads to ‘fill up’ the cartilage. Another area of bone development (ossification) occurs at the back of the heel bone. These two areas of developing bone will have an area of cartilage between them – this is how the bone grows in size. At around age 16, when growth is nearly complete, these two bony areas fuse together. Sever’s disease is usually considered to be due to damage or a irritation in this area during growth.
What are the symptoms?
Pain is usually felt at the back and side of the heel bone. Sometimes there may be pain at the bottom of the heel. The pain is usually relieved when the child is not active and becomes painful during sport. Squeezing the sides of the heel bone is often painful. Running and jumping make the symptoms worse. One or both heels may be affected. In more severe cases, the child may limp.
What causes heel pain in children?
The cause of Sever’s disease is not entirely clear. It is most likely due to overuse or repeated minor trauma that happens in a lot of sporting activities. The cartilage join between the two boney areas at the base of the heel cannot take all the shear stress of the activities. Some children seem to be just more prone to it for an unknown reason – combine this with sport, especially if it is on a hard surface and the risk of getting injuries increases. It can be almost epidemic at the start of some sports seasons, especially winter. At the start of winter, the grounds are often harder, but soften later. Children who are heavier are also at greater risk for developing Sever’s disease.
A tight calf muscle is also common in those children who develop this problem. There is a strong pull from the calf muscles via the Achilles tendon on the small growth plate at the back and the strain that this will place on the cartilage join between them.