Heel pain is a common childhood complaint, a symptom that demands attention. The number of children reporting heel pain increases in the fall and winter sports seasons. Increasing obesity in children is becoming a common cause of heel pain, even in students who take physical education classes.
Heel pain often occurs in children between eight and 14 years old. Children may have symptoms including pain in the back or bottom of the heel, limping, walking on the toes and difficulty participating in their usual activities or sports. Heel pain is common in children because their feet are growing. In children, the heel bone (the calcaneus) is not yet fully developed until age 14 or older. Until then, new bone is forming at the growth plate, a weak area at the back of the heel. Too much stress on the growth plate is the most common cause of heel pain in children.
Heel pain in children is different from the most common form of heel pain in adults (plantar fasciitis/heel spur syndrome) in the way pain occurs. Usually, plantar fascia pain is intense when getting out of bed in the morning, or after sitting for a long time and then subsides after walking around a bit. Heel pain in children usually doesn't improve like this, and walking around makes the pain worse.
Causes of pediatric heel pain
The growth plate in the heel is sensitive to repeated running and pounding on hard surfaces, pediatric heel pain is often caused by overuse. Children and adolescents involved in soccer, track, or basketball are especially vulnerable. Calcaneal apophysitis or Sever's Disease is the most common cause of heel pain in children. It is an inflammation of the heel's growth plate due to muscle strain and stress, especially in children who are active in sports or are obese. Pain and tenderness usually occur in the back and bottom of the heel when walking, and the heel can also be painful to touch. It can occur in one or both feet. Other causes of heel pain in children include bursitis to the Achilles tendon, stress fractures or other injury.
Remember, children may not complain about their heel pain. Several things can alert parents that their child needs attention such as limping, complaining, walking on toes, not wanting to play sports and pain in the heel the morning after a game.
To diagnose the underlying cause of your child's heel pain, the podiatrist will get a full history, examine the child's foot and leg, and take an x-ray to look at the heel bone.

Treatment options
The treatment selected depends upon the diagnosis and the severity of the pain. The simple RICE strategy is recommended -- rest, ice, compression and elevation, and often resolves the pain.
o Reduced activity: The child needs to reduce or stop any physical activity that causes pain.
o Cushioning the heel: Temporary shoe inserts are useful in softening the impact on the heel when walking, running, and standing.
o Medications: Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to help reduce pain and inflammation.
o Physical therapy: Strapping, stretching or physical therapy modalities are sometimes used to promote healing of the inflamed tissue.
o Orthotic devices: Custom orthotic devices prescribed by the podiatrist can help support the foot properly.
For more severe heel pain, more aggressive treatment may be necessary.
o Immobilization: Use crutches or a cast to avoid walking and putting pressure on the foot while it is healing.
o Surgery: In very rare cases surgery may be required to lengthen the tendon or correct other foot problems that may be identified.
Additional recommendations that can help prevent or reduce heel pain.
o Prevent obesity or lose weight.
o Do not walk barefoot.
o Always warm-up or cool-down when exercising with stretching exercises to help prevent injury.
o Increase activity level slowly according to the child's ability.
o Wearing the appropriate shoes can play a vital role in preventing heel pain and injury. Choose well-constructed, supportive shoes that are appropriate for the child's sporting activity.
o Wear cleats as needed during the sporting activity, but switch them often as the child's foot grows.
o Use inserts to raise the heel and support the child's foot, especially in flat-footed cleats.
o Discard shoes that caused pain, and if they are old and worn or too small.
o Never encourage your child to "play through the pain" in their feet. Foot pain is not normal and your child should never play when they are in pain. If your child has heel pain when they are playing sports, stop and see a podiatrist.
Even after treatment the heel pain can re-occur because the heel bone is still growing. It is best to stop the activity and make an appointment with your podiatrist to rule out other causes of heel pain.

o For more information email foothealth242@gmail.com or visit www.apma.org. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street, telephone 325-2996, or Bahamas Surgical Associates Centre, Albury Lane, telephone 394-5820, or Lucayan Medical Centre on East Sunrise Highway, Freeport, Grand Bahama, telephone 373-7400.

Click here to read more at The Nassau Guardian