Heel pain in children is typically caused by a condition called calcaneal apophysitis. The heel bone, called the calcaneous, has an area along the back called a growth plate, or apophysis, where growth of the bone occurs. It is along this growth plate that the heel bone becomes longer and larger over time. Sometime between the ages of ten to thirteen, the growth plate becomes inflamed and painful. This condition is part of a larger group of conditions called osteochondritis, where bone centers of growth become painful. The cause of this inflammation can be vary, although typically it simply appears on its own. Increased activity in the late elementary and middle school years may contribute as well, and injury to the heel can stimulate the condition.
Symptoms include sharp pain or achy pain on the bottom of the heel towards the back. The pain is felt when the child walks, runs, or stands in place for a while. Pain felt while at rest is rare, and generally that indicates some other condition involving nerves going into the heel. With apophysitis, the heel is sore to the touch, and squeezing it can cause pain as well. Swelling, redness, warmth, or bruising are generally not seen with this condition, and can indicate a more serious injury, like a fracture. Sometimes pain can also be felt along the back of the heel or in the arch. Achilles tendonitis and plantar fasciitis are sometimes seen with this condition due to strain from limping, causing pain in the back of the heel and in the arch respectively. While plantar fasciitis is the most common cause of heel and arch pain in adults, it is rarely the sole or primary cause of similar pain in children.
The condition is easily diagnosed, and x-rays are used to ensure no crack or fracture in the heel bone or growth plate has occurred. Treatment is simple, as the condition must generally resolve on it's own. All athletic activity and impact activity, like sports and hard play, need to be discontinued until the inflammation resolves. This can take one to three months, although in some cases only a few weeks are needed. Continued activity does not necessarily create long-term damage, but will definitely prolong the condition for many months. Stretching can help to loosen the Achilles tendon, which directly tugs and pulls on the growth plate, resulting in decreased tension so it can heal. Heel padding or heel cups reduce heel pressure, and sometimes anti-inflammatory medications are needed to reduce the inflammation further. Icing daily also will reduce inflammation. Once the growth plate has finished growing bone and has fused, the potential for apophysitis is eliminated. This generally occurs in the mid teen years. Until that point is reached, there is still a potential for previously healed apophysitis to redevelop. This does not commonly occur, but those children who develop apophysitis may benefit from orthotic inserts to stabilize the heel after the inflammation resolves to prevent reoccurrence.