Plantar fasciitis or heel spurs are the most common cause of heel pain in adults, but heel pain in children is very different to this. In children the most common cause of heel pain is known as Severs disease or calcaneal apophysitis. It affects children from around age 12 to 15 years; and is more common in boys. It is a strain in the cartilage at the back of the heel.
When we are born, the heel bone is mostly cartilage and bone develops inside that cartilage from two areas. One area is at the back of the heel bone and the other area is the main body of the heel bone. This means that in the developing child there are two growth areas in the heel bone. There is a plate of cartilage between the two bits of bone. It is at this plate of cartilage that growth occurs. The two bits of bone merge together by about 15 years of age, as no more growth is needed.
The cartilage is a weak point in the heelk bone so is vulnerable to injury. Severs disease or calcaneal apophysitis occurs when there is a strain in this cartilage. Some authorities have compared this to an adult stress fracture in the bone. High levels of sporting activity on hard surfaces is thought to be the most common casue. The most common symptom is pain at the back of the heel, which is more painful when squeezing the sides of the heel bone. It may also be painful when stretching the calf muscles, as the Achilles tendon attaches to the back of the growth plate. It is usually aggravated by higher levels of activity.
Severs disease goes away on its own eventually, in that it will always go away when the two bits of bone merge into one and there will be no long term effects. The first part of the treatment is to place some restrictions on the amount of sport that is played. A soft heel raise is also commonly used to cushion the area and relieve the pull from the calf muscles. A good foot orthotic or support is needed if the foot has any biomechanical problems. A sports shoe with gel in the heel is also often recommended.
You can ask a question on Severs Disease at the Foot Health Forum and read the latest on Severs Disease at Podiatry Arena.
