Children are resilient, but when your child begins to complain about heel pain, this must be taken seriously. Heel pain in a child is not normal. There are different causes of heel pain in a child and an adequate physical exam can help determine which type of heel pain is affecting your child.
What Is Calcaneal Apophysitis?
The most common cause of pediatric heel pain is calcaneal apophysitis (an injury or irritation to the growth plate of the heel). Typically, this occurs in boys (and girs) between the ages of 8 and 13 who are fairly active children. This is most likely to occur with a rapid increase in activity after a period of rest – such as starting rugby, soccer, netball and any in fact and sport practice after being off for a peiod of time.
Are There Other Causes of Pediatric Heel Pain?
Yes. Calcaneal apophysitis is the most common cause of pediatric heel pain. However, there are other things that can cause the heels to hurt such as stress fractures, growth plate fractures and hematagenous osteomyelitis, an infection of the heel bone.
Causes of Calcaneal Apophysitis
Causes of pediatric heel pain include:
- Rapid increase in physical activity (sports)
- Changes in training surfaces
- Changes in training techniques
- Changes in shoe gear (or going barefoot) while being physically active
- A rapid increase in growth over a short period of time
During periods of rapid growth, the bones of the leg grow faster than the soft tissues (muscles, tendons and ligaments) and the stress they place across the growth plate can cause pain and inflammation.
Symptoms of Calcaneal Apophysitis
Calcaneal apophysitis typically affects active boys and girls between the ages of 8 and 13; however, this condition can affect any active child. Early signs and symptoms include:
- Inability to participate in athletic activities
- Walking on the toes to keep the heel from touching the ground
- Pain in the heel that is worse after activity and relieved by resting
The Podiatrist will start your exam with a thorough history. This will be followed by a physical exam. During your physical exam, The Podiatrist:
- Pain and tenderness to the area of the inflamed growth plate
- A tight heel cord (Achilles tendon)
- Overall foot structure
- Abnormalities in gait
X-rays may be ordered to detect any underlying bone abnormalities.
Calcaneal apophysitis can be easily treated with changes in shoe gear, resting, icing, stretching and anti-inflammatory medications. Sometimes, physical therapy may be necessary, but this is rare.
Many times these types of injuries are unavoidable, but proper athletic shoes, stretching exercises and avoidance of obesity are some of the ways one can prevent an injury to the growth plate.
See The Podiatrist for expert care.
Being that your feet are the connection to the ground, they have to primed and steps should be taken to avoid injury that can slow you down or knock you out of the race. So whether you are training to win or simply running to run, it is important to know what foot problems can occur, and hopefully treat them before they become a marathon-breaker.
Specific Marathon Foot Issues: No matter how experienced a runner, the foot is always susceptible to running injuries, and this risk amplified during marathon training. On marathon day, however, there is specific injury risk because runners tend to me more committed to “running though” a problem (new
A method to remember marathon-related foot problems is the mnemonic “ABCD“:
Abrasions & Blisters
Cramping & Tendon Problems
Disorders of the Toenail
Provided below are explanations of marathon-related foot injuries as well as preventative measures. Should you, the reader (or runner), have any additional preventive solutions or tips for any of the running ABCD’s, please share them.
Abrasions & Blisters: Pressure points and repetitive irritation set the stage for abrasions and blisters. Common runner pressure spots are on the top of the toes, big toe joint area and the back part of the heel. Runners with bunions and hammer toes are more likely to have skin irritation. An abrasion is a simple break in the skin, whereas a blister is lifting of the skin with a fluid collection beneath it.
- Preventive Solutions:
Prevention is best form of treatment. Keep skin thoroughly moisturized, as dry
skin is more prone to tearing. Callused areas should be targeted, and urea
creams are specifically useful in breaking down excessive skin build-up.
Callus/corn removers should be used cautiously as they contain salicylic acid
and can excessively deteriorate tissue, leading to open sores.
- Socks are important in the battle
against skin irritation when running long distances. Specialty socks have
specific protective cushioned areas dedicated to pressure spots.
- Ill-fitting footwear is one of the
main reason for friction, so it’s important to have sneakers that best fit your
foot type. Also, carefully inspect the stitching at the front of the sneaker
where the toes bend to be sure that it does not rub when fully extended. Newer
sneakers are more likely to be problematic.
Bone Breaks: Fractures (aka bone breaks) are the most serious problem that a runner could develop. They typically start as a microscopic fracture (stress fracture) and can progress onto a through and through break. Most common are metatarsal stress fractures involving the second toe region. Heel strike runners may be more susceptible to stress fractures of the heel bone.
An acute stress fracture is often present with varying degrees of pain, swelling, and sometimes redness, though stress fractures may occur without you even knowing it. Running with a stress fracture is not medically advised, and most health care professionals would recommend calling off the race. Runners who don’t heed such advice may fully fracture through the bone which could lead to bone displacement (malalignment) — a potentially serious problem. Some people may have brittle bones making them more likely to develop a bone injury. Certain foot types seem to be more prone to stress fractures — very flat feet or very high arched feet.
- Preventive Solutions:
Over stressing the foot is what often leads to fractures. Pain may also be an
indicator that you are training beyond the current capability of your foot, so
it may be necessary to scale back. Pain should not be ignored, and any could be
a sign of a fracture, so seeking professional medical care is recommended.
- More cushioned sneakers do not
necessarily offer more protection from developing an injury, and running form
may be more important. Nonetheless, properly fitting running sneakers are
important to help you become more in tune with your running technique.
Depending of foot structure, orthotics may help balance the foot and take
pressure off those spots prone to stress fractures.
- Proper nutrition is important in
maintaining strong bones. Vitamin C is necessary for collagen formation, a
precursor to bone. Calcium is needed for proper bone health and Vitamin D helps
promote Calcium absorption. Eating a balanced meal should be a part of your
overall health plan.
Cramping & Tendonitis: Biomechanical and structural problems within the foot tend to manifest as shin splints, arch cramping, plantar fasciitis and/or tendinitis. Less experienced runners tend to develop these problems and is commonly the result of training past the capabilities of your foot. Tight musculature may also be at the root of cramping and shin splints. These problems tend to be self-limited and resolve with targeted treatment programs, but can set you back in terms of being marathon ready.
- Preventive Solutions: Building
strength and stamina slowly is the best method to avoid injury. Be sure to
incorporate a thorough stretching program to keep muscles and tendons stretched
and warmed up. Weak muscles within the foot can be strengthened with specific
foot training programs. Ease cramping in the foot with post-run Epsom salt
baths. Deep tissue massage is also a helpful measure.
- Arch supports (orthotics) can help
manage arch pain by providing support and perhaps better alignment of the foot
in certain people. Of course, foot type plays a big role in selecting the
proper amount of support. Running in the wrong-type of sneaker for your foot
may be responsible for discomfort, so changing sneakers may be beneficial. A
break from running may be necessary to resolve the problem. Runners with
persistent problems should seek the advice of a health care professional.
Disorders of the Toenail: A black toenail is a problem that every marathon runner has experienced, and is the result of bleeding beneath the nail plate. Pressure and friction from repetitive running seem to be the culprit. The damaged nail can be painful and often results in the toenail falling off.
Fortunately, a black toenail doesn’t typically interfere with training and common is self-limiting.
- Preventive Solutions:
Prevention is difficult, as the black toenail is often the result of prolonged
toenail irritation from the intense mileage of training. Again, properly
fitting shoes with enough room for the toenails are helpful. Keep toenails well
trimmed to not create a fulcrum for the nail to become lifted. It is unclear if
moisturizing the toenails offers any protective benefit but a soft nail may,
theoretically, be less prone to damage. Should you develop an acute painful
black toenail, then medical attention may be needed to alleviate the active
collection of blood. An irritated loose nail may become infected and this can
By the time marathon day rolls around, and if you have avoided or overcome injury during your training and your feet are pain free, then you likely have feet that are ready to start a marathon.
For any advice on footwear or if you have any problems, make an appointment with The Podiatrist.
One particular injury, known as shin splints, happens more commonly among athletes who engage in running, such as soccer players, football players and runners. Shin splints, however, are not limited to athletes of just these sports.
What are shin splints?
Shin splints is a general term but refers to many types of injuries that occur in the region of the lower leg (where the calf and shin are located). Shin splints can be caused by inflammation or injury to muscles, tendons, ligaments and bones within the lower leg. In some cases, shin splints can be caused by stress fractures in the shin bones.
What are the signs and symptoms of shin splints?
Shin splints are characterized by a great deal of pain to the lower leg, especially so in the lower portion of the shin closer to the foot. The pain usually worsens when physical activity is begun but eases as the activity continues. The pain may return once the physical activity has been discontinued but often returns later, typically the next morning, much more painful than it had been the previous day. The pain typically intensifies when the toes and foot are bent downwards. In some cases, swelling and redness can be observed in the flesh along the shin bone. Sometimes lumps can be felt beneath the skin along
the shin bone. Shin splints may make it difficult and even excruciating to walk or move.
How are shin splints treated?
There is no cure, however, there are many different treatments available that may help ease the pain associated with shin splints. Non-steroidal anti-inflammatory medications may be taken to help reduce any swelling that may be contributing to the pain. When the pain is especially intense, icing the area may help ease the pain. Shin splints can be the result of the stress of flat feet so wearing special orthopedic footwear, such as shoes with arch support or foot orthoses, may help ease the pain associated with shin splints. Sometimes physical therapy and special range of motion exercises may help ease the pain of shin splints. Strapping the affected area also helps relieve some of the symptoms. Rocktape is a very effect strapping solution for all your sports injuries. When shin splints become especially painful, medical interventions and narcotic pain medications may become necessary. Sometimes a physician may order an X-ray to determine whether or not a stress fracture may be the cause of the pain. Crutches may be needed if the pain is bad enough.
If you feel you have ‘shin splints’ or any other foot related problems, visit The Podiatrist.
Recreational athletes can push their bodies a little too much—people are exercising, walking, jogging and going to the gym and the result is that overuse injuries to the lower extremities are skyrocketing.
The flip side of this is that these active lifestyles are helping to control obesity and increase wellness and fitness. Despite many in our society becoming more active and health and nutrition conscious, children and adults are still falling further behind in the battle against obesity. We’ve got to keep pushing to educate
people, especially parents, about this struggle. The costs of health concerns associated with inactivity and obesity are staggering—they’ll break us! So stay
active and pay attention to better nutrition habits. Keep gym classes in schools.
With the huge amounts of walkers, runners and aerobics over the past 10 to 20 years, we’ve seen increases in foot, ankle, shin and knee problems. This is true whether we’re looking at the adult, especially baby boomer recreation athletes, or kids with club, traveling or school team demands. Shoe technology has come a long way in all sports, especially in running and walking. Also, it seems that the specific shoes for all sports have taken a big step up. Better support, shock absorption and conformance to specific weights are examples. Proper fit, as obvious as it sounds, is still important, so always make sure you and your children are measured and fit properly.
Foot mechanics and foot type often are one of the causes of persistent overuse problems. In many screenings and evolutions of athletes with ongoing or persistent lower extremity overuse, we see the flat or overpronating foot type. Flat feet are susceptible to strain to ankles, arches and heels. Over rotation of the lower legs or twisting of the knees can show up as compensating motions related to these foot imbalances. Shin splints or tendonitis can be the result.
Identifying your foot type or your youngster’s can help in prevention of many overuse problems.
How much is too much? If you or the young athletes are consistently sore, if overuse injuries stay with you, then evaluate the schedule. Are you running every day without enough recovery time? Are the kids keeping year-round athletic schedules? Do you need pain medicine or anti-inflammatories just to keep going?
Intelligent rest is one of the favorite terms. Getting athletes to back off isn’t easy. Somehow, the culture of playing hurt, sucking it up or pushing through pain has filtered down even to children 10 to 12 years old.
Sports can really take a toll on young, growing bodies. If your child is constantly complaining of pain or discomfort, pay attention! Check with a sports-related doctor or Podiatrist. Better strengthening, more sensible schedules, proper shoes for foot type or just more intelligent rest might be all that is needed to solve the problem.
Exercise, fitness and sports should be enjoyable and positive. Being injured, constantly tired, sore or fatigued is not.
For expert advice see The Podiatrist- specializing in Children’s foot problems