Heel Pain and Sever's Disease

Q. My son Hunter has a lot of pain in his right heel. We thought at first he had bruised his heel at school. Hunter is 10 and 1/2. We took him to a podiatrist and he did a x-ray and told us that Hunter's growth plate in his heel was inflamed. The doctor told us that he needed to stay off the foot as much as possible and put him on 400mg of Ibuprofen four times a day a day. He told us the next step would be to put a cast on the foot to keep him off of it. What would your opinion be on this matter and is there any thing we can do to help my son run and play again without pain? Hunter is very active in sports and can not imagine a cast on his foot. Hunter is 5'3 and weighs 145lbs. Kim, Belton, KY

A. Heel pain is common in children. While it can occur after a specific injury, it is also commonly caused by Sever's disease, a type of overuse syndrome, like shin splints or Osgood-Schlatter disease.

Children with Sever's disease, which is also called calcaneal apophysitis, develop microfractures where the Achilles tendon inserts on the calcaneus, the large bone that makes up the heel of the foot. These microfractures cause pain, which can vary depending on the type of activity your child is doing, and is generally worse after activity and improves with rest.

Sever's disease is more common in boys and typically occurs when a child is between 8 and 13 years old. Although it can affect both heels, it more commonly just affects one foot. Treatment can include:

• rest or 'relative' rest, in which you avoid activities that make the pain worse
• ice
• massage
• exercises that stretch and strengthen the Achilles tendon and hamstring and calf muscles (this guide from familydoctor.org does a good job of describing these exercises)
• heel pads, lifts or cups

For severe pain, a short leg cast for 4-6 weeks can be helpful. If the pain isn't too bad, you might discuss trying the exercises and heel pad first though.

As far as heel pads, some people recommend using a regular soft gel heel pad, but one that is firmer may be better. This includes the Quags Heel Cushion type of heel insert.

Plantar fasciitis is another common cause of heel pain, but unlike Sever's disease, children with this condition generally have the most pain when they first start an activity. The pain then improves or goes away after about 10-15 minutes of activity. Remember that in Sever's disease, the pain usually increases with activity and that is a good way to tell these two conditions that can cause heel pain apart.

If he isn't getting better, especially if he is unable to participate in his usual activities, and you don't feel comfortable with the idea of a cast, you might get a second opinion from a Pediatric Orthopedic specialist.