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411 on heel pain in student-athletes

by Brooke Pengel, MD
Rocky Mountain Hospital for Children

Is your young athlete complaining of heel pain?

Why is the heel vulnerable?
The heel bone is growing rapidly in children between the ages of 9 and 13.  During this “growth spurt,” the heel bone (calcaneus) is vulnerable to overuse and inflammation.  This type of growth plate is called an apophysis. When the growth plate is inflamed and painful, the condition is called Calcaneal Apophysitis (Or Sever disease/condition).

What are the symptoms?
The hallmark symptom of Sever Condition is activity-related pain that is well localized to the growth plate in the heel.  The pain can be present in one heel, or both.  Pain is made worse by the volume of running and sprinting in soccer.  The pain can be severe and may cause the athlete to limp or walk on their toes.  Swelling and bruising are typically absent.  The pain usually improves with rest.

How is it diagnosed?
A medical provider will examine the foot to determine if the pain is localized to the growth plate.  An x-ray may be obtained to evaluate for any abnormality of the heel and to determine the stage of development of the heel bone.

How is it treated?
Because Sever Condition is considered a growth spurt, the symptoms are reliably self-limiting.  The pain will resolve over time once the growth spurt has slowed down.  The pain will not reoccur once growth in the heel is complete.  During the period of discomfort, home treatment can include RICE (R-Rest, I-Ice, C-Compression, E-Elevation).  Consulting an Orthopedic/Sports Medicine specialist is warranted when pain, swelling, and trouble bearing weight persist despite such home treatment.  Sports Medicine specialists are able to make specific recommendations about treating the injury and safely returning to activity and sports. 

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