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Same Pain, Different Cause – The Rise of Heel Pain In Youth

Do you have, or do you know a youth under the age of 13 complaining of heel pain? Heel pain in the experience of Heel Pain Center of Atlanta, a specialty center of American Foot and Leg Specialists, is one of the most common ailments we treat.  The most frequent diagnosis is Plantar Fasciitis, which affects the bottom of the heel, usually around the instep.  There are other possibilities for the cause of the heel pain in adults, including tendonitis or bursitis. Although heel pain among youths is also quite prevalent, the causes vary significantly from adults.

What is the Most Common Type of Heel Pain in Youth?

Heel Pain in Severs Disease or Spikes Under Heel Plate in Cleats

Heel Pain is Caused by Severs Disease or Spikes in Cleats Under Heel Plate

Severs Disease is the most common diagnosis in athletically active youth, ages 6 to 13. Although historically this condition primarily affected  boys, Severs Disease is not gender biased, and girls now experience the condition as frequently as boys. The most frequently described symptom is pain in the back/bottom of the heel, which becomes more painful with physical activity, lessening in severity with rest. Increased sports related physical activity, combined with slight irregularities in normal gait exacerbate the atypical motion/trauma within the growth plate.  This motion/trauma is the source of the pain.

Severs Disease is actually an injury/irritation of a growth plate in the heel, not a communicable type illness.  The Achilles tendon and plantar fascia both attach to the heel bone. Motion within the growth plate space due to pull from either or both of these structures can create irritation and inflammation. The result? Pain and limitation of motion. Increased sports related physical activity, combined with slight irregularities in normal gait, exacerbate the atypical motion within the growth plate. As the growth plate begins to close as the child matures, its ability to move with the traction of soft tissue attachments becomes more limited.

What Are the Potential Treatments?

Fortunately, once the growth plate has closed entirely, usually around age 13, the condition resolves. However, if a child begins to exhibit symptoms of pain at an early age, the pain and inflammation could last for 5 or more years. Treatment is aimed at managing the pain and reducing inflammation and include:

•   Rest

•   Ice

•   Non steroidal anti-inflammatories (ibuprofen)

•   Stretching

•   Taping

•   Heel cups, heel lifts and orthotics

•   Cast or walking boot immobilization in severe cases

Benefits Of A Custom Orthotic Insert

When more traditional RICE measures do not relieve the pain cycle symptoms to the extent necessary, the most effective recommended method of treatment is a custom molded orthotic to provide stability, control of motion, and support. The intent of the orthotic insert is to maintain a neutral position of the foot in order to control the atypical pulling motions which result in pain and swelling. These are not drug store shoe inserts – they are made from a custom mold taken of the youth’s foot. Statistics indicate that with proper use of orthotics inserted into supportive shoes, approximately 85% of patients are able to re-engage in sports and other youth activities.

Are Cleats the Culprit?

Another cause of heel pain of young athletes that most people never consider has to do with the construction of their cleat athletic shoes. If a youth complains of pain on the bottom of their foot and wears cleats, take a close look at the shoe, regardless of the sport they are designed for. They are often molded with a posterior spike positioned anatomically directly below the growth plate in the heel area.  Grinding down the spike on the cleat so less direct pressure is applied to the heel upon ground contact, or replacing the shoe with a model that doesn’t have a spike positioned directly under the heel plate should significantly reduce impaction trauma and irritation to the area.

Game Changer

If you feel your child may be exhibiting the signs of heel pain attributed to Severs Disease, contact Heel Pain Center of Atlanta, a specialty center of American Foot and Leg Specialists, with four locations serving the South Atlanta Metro area for your convenience: Stockbridge, Fayetteville, Locust Grove and Forest Park. Don’t wait for the symptoms to resolve on their own. We can help change the game pain.