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PEDIATRIC HEEL PAIN

Posted by LISA M on 5/09/03 at 20:47 (118209)

My son Alex is suffering from heel pain. He went to Foot Dr today and the Doctor had said he has flat foot and she said Seavers Disease also. When I looked up Seavers Disease it ONLY mentioned the hip, knee and thigh. My question is what is it called when the bones in the heel have not yet grown together and there is imflammation in between the two bones?? My son is 9 and plays alot of baseball and suffers tremendously, limping and swelling in the ankle and tender to the touch. I was told to ice it after exercise and give him advil for pain. Is there anything I can give him or do BEFORE his baseball?? His achilles tendon is very tight and she gave him exercises for that.

Re: PEDIATRIC HEEL PAIN

Ed Davis, DPM on 5/09/03 at 23:03 (118215)

Lisa:
Sever's disease only exists in the heel, not the hip, knee and thigh. It is part of a category of diseases termed 'juvenile osteochondroses' of which other types affect different parts of the body. Sever's disease is an inflammation of the growth plate of the heel bone also termed calcaneal apophysitis. An apophysis is a growth plate to which a tendon is attached -- the achilles tendon attaches to the back of the heel.

It is fairly easy to cure. What is the treatment plan that your son's doctor has provided? I am not very enthusiastic about having to give children pain medication to allow participation in sports. Most cases of calcaneal apophysitis or Sever's disease can be resolved in 3 to 6 weeks so it is far preferable to slow down his activity for the short period of time it takes to achieve a cure.
Ed

Re: PEDIATRIC HEEL PAIN

LISA M on 5/10/03 at 08:39 (118227)

Alex's Dr's treatment plan is to exercise the achilles tendon 3-4 times a day and ice his feet after he plays baseball, also give him advil after he plays.

Re: PEDIATRIC HEEL PAIN

Ed Davis, DPM on 5/10/03 at 14:48 (118239)

Lisa:
I don't want to interfere with the doctor-patient relationship, nor do I practice medicine online but that simply does not sound like much of a plan considering what you have posted. Are you in an HMO? Was the doctor you had seen a podiatrist?
Ed

Re: PEDIATRIC HEEL PAIN

LISA M on 5/10/03 at 19:43 (118265)

Are you a Doctor? And yes i did go to a Podiatrist. And I do not have a HMO i wouldnt have that kind of insurance it is garbage insurance.. I have one of the best plans there is.... another thing, You did not answer my original question on what to do BEFORE he plays sports. Dont answer that if you are not a Doctor... a PODIATRIST.

Re: PEDIATRIC HEEL PAIN

Dr. Z on 5/10/03 at 19:56 (118268)

I like to use heel cups. There is also an insert on this web site called
Powersteps. Stretching Stretching stretching before excercise is very important. If you want to read more about this condition called sever's disease either use the search engine or go to my web site http://www.thefootspecialist.com . There is some very good information about this problem.

Re: PEDIATRIC HEEL PAIN for Dr Z

LISA M on 5/10/03 at 21:13 (118272)

Dr Z
I just finished stretching my sons feet and I found another spot of pain. On his left foot (the worst of the two) when I pushed his toes up his outer foot not his arch but the opposite side had alot of pain. when I stretched his foot pushing his little toe side up his pain was extreme in the outer foot area, not the heel area. Is this associated with severs or flat foot??? Im getting very confused and concerned about this.
Thank you, Lisa

Re: information about the doctors

Suzanne D on 5/11/03 at 06:43 (118279)

Lisa, Ed Davis is a Doctor of Podiatric Medicine (hence the DPM at the end of his signature) who posts here along with Dr. Z and others to help those of us who ask questions. They receive no compensation for this but do so out of the goodness of their hearts.

I have read and posted on this site for almost two years and have found their advice and expertise to be above reproach. (I do not know any of them personally nor have I ever been to any of them as a patient.) If you want to set your mind at ease, go to the top of this 'Ask the Doctors' page where there is a paragraph which lists some of their names. You may click on the links to read about their credentials and practices.

I hope your son gets better soon. As a long-time reader, I am just trying to be helpful...

Suzanne :)

Re: PEDIATRIC HEEL PAIN for Dr Z

Dr. Z on 5/11/03 at 08:43 (118290)

There are other growth plates in the foot that can be injured or painful.
You really need to have a doctor that treats alot of this to examine his feet. Abnormal biomechanis can contribute to this. The type of stretching that we are talking about are achilles tendon wall stretches. Taping is very helpful also. Sometimes a cast maybe needed So my advice is to go to a podiatrist that is going to explain and show you exactly what is going on. I hope that this is helpful In addition I have an excellent section on my web site that you can read. http://www.thefootspecialist.com

Re: PEDIATRIC HEEL PAIN for Dr Z

LISA M on 5/11/03 at 18:18 (118347)

Dr Z
Yes that was very helpful to find out that my son must stretch stretch stretch BEFORE he plays ball. He has the wall exercises he does 3-4 times a day and I'm pushing him to do them more often, the more the better. I have another appointment with his podiatrist on Friday and I will be asking alot of different Q's. Thanks again for the answers, you helped my understanding tremendously.

Thanks again, Lisa

Re: PEDIATRIC HEEL PAIN for Dr Z

Dr. David S. Wander on 5/11/03 at 18:30 (118348)

Lisa,

I treat a lot of young athletes with Sever's disease. In my office, it is most prevalent in young soccer players. Studies have shown that when wearing soccer cleats, the heel actually sits lower than the rest of the foot, therefore putting a lot of stress on the Achilles tendon. Sever's most often occurs between 8-12 years of age and is very common in young athletes, especially soccer and basketball. Soccer shoes in particular have been blamed for increasing the problem due to the above mentioned reason.

Baseball shoes for young players are very similar to soccer shoes, and also place the heel below the rest of the foot when standing. My recommendation is to purchase a soccer shoe called a 'turf shoe' (these can be used for baseball). It has a different cleat design and has some elevation and cushioning not seen in traditional soccer shoes or youth baseball shoes. Often, the use of a turf shoe, with a heel lift (must be used in both shoes), gentle stretching and ice, can relieve the majority of symptoms. The best soccer 'turf' shoes are made by Adidas, Kelme and Puma. Good luck.

Re: PEDIATRIC HEEL PAIN for Dr Z

LISA M on 5/11/03 at 18:41 (118350)

Yes that was very helpful and I believe that would help my son. I will get him a pair of TURF shoes. Thank you, alot of Doctors on this site have helped me understand this disease. I really appreciate it.

Thanks again, Lisa

Re: PEDIATRIC HEEL PAIN

Ed Davis, DPM on 5/12/03 at 11:22 (118408)

Lisa:
There is nothing special to do before your son plays sports other than cure the problem -- something that you do not seem to be doing. Based on your attitude, there is little more I will add.
Ed

Re: Treatment of Seaver's Disease

Ed Davis, DPM on 5/12/03 at 13:28 (118415)

Suzanne:
Thank you for your post. For the benefit of readers here I will outline my general approach to Sever's. I have a lot of school age children in my practice with this diagnosis.

Sever's disease is an inflammation of the growth plate in the heel bone. It generally is most symptomatic at approximately 18 months from closure to the time of closure.

All children have the growth plate so there are underlying reasons why some have the problem and some don't. Those reasons are largely biomechanical. Torsional strain on the plate occurs when the heel bone has excess side to side motion which occurs with overpronation. The poster referred to 'flat feet' but 'flat' and 'overpronated' feet are often confused -- the confusion would be hopefully removed by a visit to a professional. I have found that an orthotic with an extra deep heel cup and rearfoot post will mitigate or alleviate the pain associated with calcaneal apophysitis in as little as two weeks.

Other biomechanical factors include shoegear issues. A number of shoes have a heel that drops below the level of the toes, including many soccer shoes and some baseball cleats can exaccerbate the problem, particularly if the achilles is tight (as noted by Dr. Wander). A solution is to change shoes to a recommended model or to modify the shoes by adding a lift in between the outsole and midsole of the heel area. Stretching of the achilles/gastrosoleus should be done if tight and is more of a long term issue.

If a child is having severe pain with sports, rest is required. Very occasionally casts are required. Unfortunately, in a number of cases children have become 'gladiators' and entertainers for their parents. They are NOT professional athletes and we do NOT need to 'give them something' so they can play/perform the game (yes-- it really is a game) through pain. Parents who ask for that are the ones who really need the help -- I will show that type of parent the exit door to my office.

The poster here describes a minimalistic approach to Sever's which is unusual, particularly if the problem is 'severe' or causing a child to limp. It is an approach I have primarily seen with HMO patients, which was the reason for my query.

Again, this response if for the benefit of readers here as opposed to a specific poster.
Ed

Re: PEDIATRIC HEEL PAIN for ED

LISA M on 5/12/03 at 21:42 (118486)

Ed, If his podiatrist told me to have him stop playing, I would. I have reduced his playing from 6 out of 7 days to 3 out of 7. Not from what his podiatrist said but from me. To see my son in pain is a very hard thing for me.... I walked off the field at a practice because I was crying so hard. So please don't read me wrong.... I want the best for my son, the pain he feels must not be as bad as I seem to see it... because he doesn't even want to slow down... I'm forcing him to cut it in half. His love of baseball is like his whole world. I'd rather him quit. I understand your belief he should quit or postpone his playing. I live with painful Rheumatoid Arthritis daily myself, and I'd rather him not have any pain. He just doesnt want to quit...

To address the issue of HMO..... honestly I was insulted.... to say the least and appologize if I came off nasty.. I didnt mean to be.
Thank you,
Lisa

Re: PEDIATRIC HEEL PAIN for ED

Ed Davis, DPM on 5/13/03 at 00:35 (118498)

Lisa:
I posed the question because I could not understand why your son is not getting more comprehensive treatment for his problem. Based on what you have posted, he is in a lot of pain but your doc appears to have recommended very little definitive treatment -- I don't understand why. I have to repeat again that I am not privy to the interaction between you and his doctor but I have to question if the doctor is taking the problem seriously. I have described the basics of treatment for this problem. If the basics are done, then your son may only need a brief respite. All athletes irrespective of how dedicated or paid will take the necessary time to heal an injury. Sometimes, professional athletes who make big bucks will sacrifice their bodies for the money but that is not an option for an aspiring amateur athlete. He needs to get healed effectively and expeditiously so that he can enjoy the game and be in good condition for the future.
Ed

Re: PEDIATRIC HEEL PAIN for ED

LISA M on 5/13/03 at 20:57 (118625)

Ed
Yes I agree and I will be questioning his podiatrist this friday. I appreciate your insight on his problem. Thank you!
Lisa