Fox Mill Foot and Ankle Center

Heel Pain in Children
© 1999 by Seth A. Rubenstein, D.P.M.

Heel pain in children is produced by a tight Achilles tendon combined with rapid growth of the leg bones.This places a traction force (pulling) at the insertion of the Achilles tendon into the back of the heel bone.

In children, there is a thin band of cartilage in the back portion of the heel bone called a growth plate (see x-ray image, right above). As the name implies, new bone is formed at a growth plate, which also exists in other bones such as the leg bones, arm bones, etc.

As a child goes through a "growth spurt" the rapidly elongating leg bone stretches out the Achilles tendon which in turn pulls tighter on its insertion into the heel bone. This pulling effect usually does not cause a problem. However when a child is very active (playing sports such as soccer, or basketball) the increased activity creates further tightening of the tendon. The resulting traction force is absorbed into the heel bone (see illustration, left above).

As cartilage is softer than bone, the thin growth plate frequently becomes irritated and painful as the traction force increases. This pain is worse following sports related activity and usually occurs between the age of 8 and 13 years old (photo, right). The pain is noted not only under the heel but also with side to side compression of the bone.

Differential diagnosis (other causes of heel pain) include fracture or bone tumor, so x-rays are usually performed in evaluating this condition.

Treatment includes rest, ice and antiinflammatory medication. An arch support and heel lift are both helpful. For severe cases, a non weight bearing splint or cast may be applied. Long term treatment usually includes use of functional orthotics. The problem is self limiting and goes away after the growth plate closes, around the age of 13 to 14 years old.