Pain in the heel of children is not common, but when it does happen the most common reason is a condition known as Severs Disease. This is pain that develops in the back of the heel where the Achilles tendon inserts into the heel bone. The most common symptom of this is pain on activity and pain on squeezing the sides of the heel bone near the back.
Before we are born almost all bones in the body are a cartilage shell that is used as the framework for building bone. In the heel bone, the main part of the bone starts developing in the middle. There is also a flat plate of bone that starts developing at the back of the heel. Up until around the age of fifteen years, a small piece of cartilage separates these two growth areas of bone. It is at this cartilage that allows normal growth to occur. Around age fifteen years, these two areas of bone fuse to make one heel bone. Before this age, there can be some sort of strain of this cartilage area that can become painful, resulting in Severs Disease. Some like to consider this to be a stress fracture of the cartilage. It is more common in active children especially on hard surfaces as this adds more load to the growing area. The forces from the Achilles tendon also put a lot of strain on the growing area.
SEVERS DISEASE
The first stage in treating this is some sort of activity modification. The child will need to cut back, but not necessarily eliminate, sporting activities to give it a change to heal. Heel raises inside the shoe are often used. The heel raise helps reduce the pull from the Achilles tendon and provides some cushioning to the damaged area. Sometimes strapping is also used to help reduce the pull of the tendon on the bone. Occasionally, some anti-inflammatory medication is needed to help settle it down. Foot orthotics have been reported as being helpful in those with biomechanical problems. If this does not help, then complete rest from sport is needed, and even a walking cast may need to be applied. This condition is self limiting, in that they will outgrow it by the time they reach age 15 or so when the bone fuses into one. However, there is plenty that can be done to help the symptoms before then.
Severs Disease of the Heel in Children SEVERS DISEASE
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