Is it growing pains or something else?
Heel pain is a very common symptom in adults, but children and teens may also complain of it. Most often the discomfort is short lived, caused by a growth spurt, especially in active kids. However, there are several other conditions that can cause heel pain in young people. Try to determine when it may be normal growing pains and when heel pain may indicate a more serious condition.
Address pain early, avoid long recovery
The American College of Foot and Ankle Surgeons stresses that athletes should never “play through the pain” in their feet. Left untreated, heel pain can lead to difficulty in walking that will require complicated therapy.
Growing Pains Affecting the Heel
During a growth spurt, your child’s heel bone grows faster than the muscles, tendons, and ligaments in her leg. In fact, the heel is one of your child’s first body parts to reach full adult size. When the muscles and tendons can’t grow fast enough to keep up, they are stretched too tight.
If your child is very active, especially if she plays a sport that involves a lot of running and jumping on hard surfaces (such as soccer, basketball, or gymnastics), it can put extra strain on her already overstretched tendons. This leads to swelling and pain at the point where the tendons attach to the growing part of her heel.
During growth spurts, a bone may grow faster than muscle, resulting in muscle or tendon strain that causes mild pain or discomfort. It tends to occur late in the day or at night, after a busy day of activity.
The calcaneus, also known as the heel bone, has an area where bone growth occurs (known as an apophysis). It is located at the back of the heel bone, near where the Achilles tendon attaches. This growth plate is subject to pulling and tension from the tendon, which can lead to a painful heel.
Calcaneal apophysitis, which is also called Sever’s disease, usually occurs between the ages of 7 and 14. The condition can be aggravated by increased activity, especially if there has been strain placed on the Achilles tendon from such activities as jumping or sprinting. Examples include heel pain from soccer and basketball.
Like calcaneal apophysitis, Achilles tendonitis is brought on by strain on the Achilles tendon, either by increased activity or tightness of the calf muscles, which kids commonly experience during growth spurts. The tendon is painful with activity (especially running and jumping) and in the morning there is often pain and stiffness.
Bursitis can also cause pain and swelling near where the Achilles tendon attaches to the heel bone. Bursitis is inflammation of a bursa, which is a pocket of fluid adjacent to the tendon. Bursitis is caused by tendon strain or irritation of the tendon from rubbing against a tight shoe.
Pain on the bottom of the heel may be caused by plantar fasciitis. The condition is caused by inflammation on the underside of the heel bone, where a band of connective tissue called the plantar fascia attaches. Plantar fasciitis is often caused or aggravated by problems with foot function, such as flat feet or high-arched feet. Children will usually say that their heel pain is worse in the morning and with activity.
Less Common Causes
Seek a medical evaluation if treatment for the common causes of heel pain does not result in improvement. Here are less common, but more serious conditions that can cause heel pain.
- Inflammatory conditions such as juvenile rheumatoid arthritis and juvenile spondyloarthropathies can cause heel pain. The juvenile spondyloarthropathies include reactive arthritis, psoriatic arthritis, and ankylosing spondylitis.
- Congenital bone fusions, also known as tarsal coalitions
- Bone fractures
- Ulcerative colitis and Crohn’s disease
- Tumors or bone cysts—rare causes of pain that are diagnosed by X-ray or another imaging study
What all of these conditions have in common is that they are caused by physical stress on the feet. Once a diagnosis has been made, the treatment plan will likely involve rest and daily stretching of the ankle and foot. Sometimes physical therapy is recommended to improve flexibility and strength.
If structural or functional problems with a child’s feet are contributing to the heel pain, a podiatrist may prescribe or recommend shoe orthotics or some other change in footwear. An ankle brace or support may also be prescribed.