Understanding Heel Pain in Children
A 10-year-old boy presented at Leading Edge Podiatry with heel pain in both feet for approximately 6 months. His mother had previously taken her to the family’s GP, who referred for X-ray and ultrasound imaging to check for plantar fasciitis. The imaging results did not find any clear signs of plantar fasciitis. The GP suggested that an expert podiatrist should be consulted for the most accurate diagnosis. The boy was a competitive football and basketball player, training 3 times a week and competing on weekends, in addition to his regular physical activity sessions at school.
Patient’s Pain Symptoms: Plantar Fasciitis or Sever’s Disease?
He reported that the heel pain was present in both feet. The onset of pain was when exercising after approximately 15-30 minutes. He would struggle to finish the game and sometimes be substituted off the team. He would also report it was very painful again when he finished exercising. It would sometimes have residual pain for the remainder of the day.
Examination and Assessment: Plantar Fasciitis or Sever’s Disease?
While plantar fasciitis is the most common heel pain and experiencing end-of-the-day pain is common further assessment was required. Sever’s disease is a common cause of heel pain in children between 7 and 14 years of age who are physically active. The podiatrist carried out a thorough examination, beginning with a comprehensive history-taking. The patient’s feet were examined and palpated; the pain was worse when squeezing the heel bone. The podiatrist also assessed the boy’s range of motion and strength in the foot and ankle joint, and the flexibility of his lower leg and foot muscles, ligaments, and tendons.
The podiatrist conducted a biomechanical assessment and gait analysis as part of his diagnostic process. The biomechanical assessment was conducted by placing markers on the patient’s lower legs and recording footage of his walking on the treadmill.
Significant Findings of the Examination for Plantar Fasciitis or Sever’s Disease
The patient felt minimal pain when the podiatrist applied pressure to the plantar aspect of the heel (the area where the plantar fascia ligament connects to the heel bone). There was a heightened pain response when the podiatrist squeezed the back of the patient’s heel on the painful foot (growth plate). The patient had tight calf muscles, restricting the range of motion in the ankle, he would pronate with his ankles rolling in.
Effective Diagnosis and Treatment Strategies for Sever’s Disease
The podiatrist diagnosed the patient with Severs. The patient was advised to rest from football and basketball for a couple of weeks and to avoid any other activities that caused pain. The podiatrist recommended an exercise plan to stretch the calf muscles and plantar fascia and to strengthen the muscles of the foot and ankle. The patient was also fitted with custom-made orthotics to support the arch of the foot, slight heel raises, and reduce ankles rolling in. The patient was advised to wear supportive shoes with a cushioned sole and to avoid walking barefoot.
Recovery Journey: From Pain to Play
After 6 weeks of treatment, the patient reported a significant reduction in pain and was able to gradually return to sports. Initially completing a training session, then one training session and a game before returning to normal physical activities. The patient was advised to continue with the exercises and to wear the orthotics as directed.