PODIATRY AND OSTEOPATHY

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Podiatry: Persistent heel pain in children and adolescents.

The healthy foot in childhood and adolescence. Before I discuss the more common causes of heel pain it is important to distinguish between a healthy and unhealthy foot in the child and adolescent.

Healthy feet

The foot is flexible and the joints are mobile, with no pain or swelling. In a child, the foot begins to adopt an adult foot shape by around the eight-year mark. In normal walking the foot undergoes distinct heel-to-toe movements.

Unhealthy feet

The foot is inflexible, either with a very high arch, or with a very low arch. The child "toe-walks", and does not heel-to-toe. There is a delay in the young child walking or running. There is pain, stiffness or swelling in some of the joints in the feet.

There are two common causes of heel pain in the young foot. These are the rather startlinglingly named Severs Disease and Haglands Deformity - they are both relatively common, and require little treatment, if any.

A third, much more serious condition which can cause heel pain in children and adolescents warrants a mention. This is disease within the heelbone itself. This can take the shape of infection or a tumour, both of which, thankfully, are fairly rare in relation to Severs Disease and Haglunds Deformity. X-rays are needed to diagnose infection or tumours, and if suspected, an appropriate referral to the family doctor will ensure that the patient is put onto the right lines for speedy, effective treatment.

Severs Disease is a strain on the growth plate in the heelbone. It usually affects boys, aged 8 - 13. It is associated with playing sport and the patient will normally complain of a dull ache in the heel.

Haglands Deformity

Haglands Deformity is common in adolescents, and presents as a painful bump at the back of the heel. It can be caused initially by a shoe that is too tight at the heel, or by the position of the heel in the shoe, or a combination of both. The swelling, which is usually red and sore to pressure, is normally confined to the soft tissues, and will respond to 10-minute massages with ice once the offending shoe has been discarded. In more persistent cases the back of the heelbone is also affected, and in very severe cases it may be necessary to have a small operation to remodel this.

What to do

Severs Disease normally clears up on its own. If it is painful or distressing to the patient, professional help should be sought. Sometimes a rigid foot orthosis is required, to splint the foot and rest the heel. This has the additional benefit of allowing the patient freedom to use the foot normally, and continue playing sport. Haglands Deformity can also clear spontaneously, provided a little common sense is applied. Use ice as outlined above, be fairly ruthless with footwear, because one favourite pair of shoes could end up damaging the heelbone. Again, professional help should be sought if the condition does not improve. Advice from an "outsider" may be more likely to be taken on board than that given by a parent, who may simply be perceived to be nagging.

Any heel pain which persists, particularly in the younger patient, should be taken seriously and examined by an experienced Podiatrist. The diagnosis, and ensuing professional advice, may result in no treatment being needed, but at least you can be sure that appropriate action has been taken. The clear message here is that whilst we don't want to make patients out of our kids unnecessarily, sometimes its worth a visit to the appropriate health professional, even if only for piece of mind.

David Holland BSc(Hons), MSc(Dunelm), MChS