The fun and lazy days of summer are coming to an end as we find ourselves trying to get back into the routine of school, homework, and fall sports! For a growing child, the transition from casually running around in camp, swimming, and playing videogames can be a little tricky as coaches start pushing running laps, suicides, and other repetitive drills to get into shape for the football, soccer, and track seasons.
It is not uncommon for your growing child or teenager to complain of heel pain at the beginning of a sports season, because the heel bone typically grows more quickly than the leg bones. The heel is the attachment site of the gastrocnemius and soleus muscles as they join together in what is known as the Achilles tendon. While boasting itself as the largest tendon in the body, the Achilles bears a lot of load with each push-off that we walk, run, cut, decelerate, and jump. Having gone through a recent spring or summer growth spurt and ramping up the intensity of physical activity without proper stretching and warm-ups can cause inflammation with discomfort at the heel.
Sever’s disease, also known as calcaneal apophysitis, is an inflammatory condition of the growth plate in the heel of growing children caused by repetitive overloading of the Achilles tendon. It tends to be more common in boys between the ages of 7 and 15, especially during a growth spurt or at the beginning of a sports season. In some cases, your child may complain of one heel hurting or both, but the heel pain is usually more towards the end of the day or after running and jumping activities. There typically is no swelling or redness or bruising with Sever’s, but there may be pain upon squeezing the tendon close to the heel.
Whether your child has a temporary bout of tendonitis, bursitis, or Sever’s disease, the condition is treatable and potentially preventable. If your child’s symptoms are persistent and severe or are also accompanied by a fever or pain at multiple joint sites, it is recommended that you see your pediatrician for further evaluation. Here are some recommendations to potentially prevent and treat this kind of heel discomfort:
- Before pushing yourself too hard at practice, take time to warm up by gradually increasing your speed and intensity with gentle all body movements.
- Remember to stretch your hamstrings, calf muscles, and hip flexor muscles as needed. Each count should be held for 30 seconds and 3-5 repetitions performed on each leg.
- If your calf muscles are a little weak, you should include focused strengthening of these muscles. One example is to stand with both feet together and rise up on tiptoes, eventually challenging yourself to one-legged heel raises when you can do so without pain.
- Practice single limb stance balance activities. For fun, you can brush your teeth while standing on one leg!
- Remind your coach to include core and hip strengthening when training.
- Allow time for a cool down after activity. For example, walk for a few minutes and stretch your legs.
- Parents check for proper footwear. Shoes, sneakers, and cleats with arch support that are not worn out are best. A heel cup or shoe insert may help in some cases. Your orthopedic doctor or pediatric physical therapist can offer some suggestions.
- Be mindful that your child may have to take a break from running and jumping activities for 2-3 weeks to let the inflammation calm down in more moderate and severe cases. This interim is a good time to cross train, stretch, and strengthen and ice the heel if needed to return to sports pain-free.
Siobhan Clarke is a doctor of physical therapy, pediatric certified specialist, and Advanced Clinician at the CA Technologies Pediatric Rehabilitation Center at Hospital for Special Surgery. She is trained in clinical gait analysis testing and works closely with orthopedic surgeons, physical and occupational therapists, and social workers in the Leon Root Motion Analysis Lab and at Hospital for Special Surgery’s Cerebral Palsy Clinic.