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Podiatric Surgeons Urge Prompt Treatment for Growth Plate Injuries

Indoors and outdoors, child athletes stay active year round in competitive sports, and for many of them heel pain occurs as often as missed free throws. Local podiatric surgeons warn that when a child complains of heel pain, it should be treated right away and might be a warning sign of acute bursitis, stress fractures or other serious foot problems.

Marybeth Crane, DPM, FACFAS, a podiatric foot and ankle surgeon with Foot and Ankle Associates of North Texas in Grapevine, says heel pain occurs frequently in children ages 6 to 14 as their feet grow and the heel bone develops. "As more children get active in competitive sports, they increase their risk for growth-plate injuries and subsequent heel pain. Soccer players, for example, run a great deal and wear cleated shoes, which are not very supportive," warns Dr. Crane.

She adds that children and adolescents often are reluctant or unable to give a complete history or cooperate with a physical exam, so a thorough work-up is required to pinpoint the exact cause of the symptoms.

"New bone forms in an area behind the heel, known as the growth plate, and cartilage is vulnerable to severe inflammation from strain or stress. With repeated stresses and strains from overactivity, the heel becomes very painful," Dr. Crane explains.

Even though growth-plate trauma is the leading cause of pediatric heel pain, Dr. Crane says the condition can be difficult to diagnose. She cautions that parents should be concerned if a child has pain in the back or bottom of the heel, limps, walks on the toes, or seems to have difficulty participating in normal recreational activities. To achieve an exact diagnosis, podiatric foot and ankle surgeons thoroughly examine the child’s foot and leg and often take x-rays. In some cases, the doctor might use more sophisticated imaging tests, such as an MRI or CT scan, to rule out serious but less prevalent causes of heel pain, such as:

Bursitis and Tendonitis:
Tendo-Achilles bursitis occurs when the sac between the Achilles tendon and the heel bone becomes inflamed due to an injury, possible onset of juvenile rheumatoid arthritis, or from wearing shoes with poorly cushioned heels. Tendonitis is an overuse injury occurring mainly in adolescents over 14 in which the Achilles is stressed and inflamed from repeated running and pounding.

Fractures:
Sometimes hairline or stress fractures result from repeated pressure on the heel bone and can occur in adolescents involved in competitive sports. Small children also get heel fractures from jumping off furniture or stairs.

Depending on the severity of the child’s heel pain, treatments range from simply reducing physical activity to surgery. In most cases, mild or moderate heel pain can be treated successfully with shoe inserts to soften the impact on the heel, anti-inflammatory medications, stretching and physical therapy. In severe cases, the foot and ankle will be immobilized in a cast and, in some instances, surgery might be necessary to lengthen the Achilles tendon or correct another problem.

Pediatric heel pain often returns after treatment because the growth plate is still forming until the age of 14 or 15. However, the risk for recurrence can be lowered by choosing well-constructed shoes with good support and restricting use of spiked athletic shoes, especially on hard fields. It also is advised that young athletes avoid competition that exceeds their physical abilities.