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The Informed Parent

Heel Pain

by John H. Samson, M.D., F.A.A.P.
Published on Oct. 15, 2012

Soccer season is here! And with this active sport frequently comes complaints of pain in the child’s heel. In my own experience, it is equally as common as the knee pain associated with Osgood-Schlatter’s Disease. In fact, the disease process that leads to the heel pain is essentially identical to that of Osgood-Schlatter’s Disease.

The body has many cartilage/bone centers that have limited blood supplies. The one at the end of the heel and the one on the tibia just below the knee seem to be the most commonly involved. Some researchers feel it is because they are in areas frequently traumatized. It is thought the meager blood supply to these areas is blocked due to repeated minor injuries. The bone becomes soft and degenerates.

This process of degeneration due to lack of blood flow is called necrosis. Thus, the area becomes painful as a warning that care to the part is needed. In time, if the area is protected, the blood supply is restored, the cartilage and bone are revitalized, and the condition is cured. The name given to this condition involving the heel is Sever’s Disease, whereas the same condition in the knee area is called Osgood-Schlatter’s Disease.  

Having established how it happens, what do we do to alleviate the pain and allow healing in Sever’s Disease? There is no question that not using the heel will hasten the cure, but this becomes an untenable solution. Not only must children run, but they must walk in school, etc. Most cases respond very well to using a heel pad. This protects the heel from repeated trauma.

There are several commercially available heel pads that work nicely. Spenco Heel Pads and Tulli Heel Cups are two that I use most frequently because they are readily available in sports shoe stores. The pad must be worn at all times in both shoes, even though only one heel is involved. Prolonged barefoot walking and my barefoot running must be avoided.

In some cases the heel pad, when used in the hard plastic-soled cleats, is insufficient. In these cases I have the patient get the soft, small-cleat-soled, all sports shoe (similar to artificial turf shoe). These shoes with the heel pad or cup inserted solve the problem without the patient missing athletic activity.

In very small number of patients, control of the pain is only achieved by not walking or running on the foot for several weeks. This necessitates crutch walking or at times even casting to assure non-use of the foot. These extreme measures are usually needed in cases where there has been a long delay in instituting therapy.

If the simple measures described  do not immediately alleviate the pain, the patient should be seen by a physician to be sure no other condition is present. Furthermore, if the discomfort is severe, the child should be examined before any measures are taken.

Whether it be Sever’s Disease or Osgood-Schlatter’s Disease, ignoring the pain and hoping it will go away only delays the starting of the necessary treatment. A delay may necessitate the use of more extreme treatment measures.

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