Heel Pain Is Very Different In Kids Vs. Adults. Here’s How!
Whether you’re getting heel pain in those first few steps in the morning, during or after exercise, or all day long, there’s something that all of our patients can agree on: heel pain is frustrating, tender, and can severely impact our ability to do the things we love. With up to 10% of all people developing heel pain in their lifetime, it’s a big problem currently plaguing many New Zealand families.
When it comes to children and adults, the main causes of heel pain can vary greatly – and require very different approaches to treatment. Today, our podiatry team thought we’d shed some light on the different causes of heel pain, how they differ in kids compared to adults, and a game-changing treatment we have available here at Marlborough Podiatry: shockwave therapy.
Adult heel pain
Thinking of the two most common causes of heel pain that we see in our clinic day in and day out, two conditions immediately spring to mind: plantar fasciitis and Achilles tendonitis.
Plantar Fasciitis
Don’t be put off by the term – plantar fasciitis simply means the inflammation of a tissue (a fascia) at the bottom of your foot. Our patients best describe plantar fasciitis heel pain as excruciating pain at the bottom of the heel for the first steps in the morning, that can ease after a few minutes of walking but recur when standing again after rest. It is most commonly seen in women between the ages of 40 and 70 years, particularly if they are overweight.
Many people mistakenly refer to plantar fasciitis as ‘heel spurs’, though this isn’t technically accurate as a heel spur is a type of bony spur (hard calcification) that develops on the bottom of the heel bone. You do not have to have a heel spur to have plantar fasciitis heel pain, as, by definition, plantar fasciitis is the inflammation of the plantar fascia tissue.
The most common causes of plantar fasciitis include overusing and straining the fascia from increasing the intensity or duration of exercise, having a flat (pronated) foot posture, wearing unsupportive footwear, and any activities, whether sports or work-related, that see you spending large quantities of time on your feet. All these causes lead to overusing the fascia, resulting in damage, inflammation and pain.
Achilles Tendonitis
Achilles tendonitis describes the damage that occurs at the insertion of the Achilles tendon at the back of the heel. If you put your fingers on the very back of your heel and feel a cord-like band, that’s your Achilles tendon. Your Achilles is the thickest and most powerful tendon in your body, playing a critical role in helping your foot to push off the ground with every step you take, which is integral in all walking and running activities.
Achilles tendonitis is characterised by pain and swelling at the back of the heel that may radiate up the back of the leg. You may have some stiffness around your ankle, and actions like going up onto your toes or walking uphill may become difficult. Any activities that overuse, strain and place an abnormal load on the tendon can lead to it becoming damaged. This includes a sudden increase in training intensity and duration (especially if it involves going uphill), wearing unsupportive footwear or those that have low-set heels, having tight calf muscles, poor foot posture or biomechanics, running and jumping sports – and plenty more.
Other causes of adult heel pain
There are plenty of other causes of heel pain in adults that aren’t as common as plantar fasciitis or Achilles tendinopathy, but still cause plenty of problems for many people. These include:
- Bursitis
- The breakdown or inflammation of the fat pad at the bottom of the heel
- A stress fracture to the heel bone
- Posterior tibial tendon dysfunction (PTTD)
- Bony bruising
- Ankle impingement leading to nerve compression (tarsal tunnel syndrome)
- Arthritic damage or changes to the heel bone
Kid’s Heel Pain
Sever’s Disease
When it comes to heel pain in kids, there’s one cause that trumps the rest in terms of prevalence – Sever’s disease. Also known as growing pains in the heels, Sever’s is a temporary, painful condition that affects active and growing kids, usually between the ages of 8 and 15 years old. This means that it cannot be present in adults.
While bones are growing, they have areas called growth plates at the bone ends where new bone is added by the body so that our bones grow bigger. When we reach full maturity and stop growing, these growth plates turn to solid bone. While they’re present, however, growth plates are more vulnerable to damage than the surrounding bone. When the growth plates are irritated and cause pain, this is known as Sever’s.
The cause of the growth plate irritation is often a tight or overused Achilles tendon that repeatedly pulls on the back of the heel. It may also occur from impact to the heel bone itself, like from running on hard surfaces. The cause of a tight or tense Achilles tendon in kids includes:
- A faster rate of bone growth than muscle growth, resulting in a shorter Achilles tendon
- Increasing the intensity of physical activities that repetitively pull on the heel
- Running sports
- Soccer boots and low-heeled shoes
Note: growing pains can also affect the knees. We’ve shared all about this here.
Other causes of kid’s heel pain
Due to their tendency to run all day, sometimes with bare feet, and jump off high surfaces without a second thought, another cause of heel pain that we see semi-regularly is stress fractures of the heel bone. Unlike regular fractures (your typical ‘broken bones’), which tend to occur suddenly, stress fractures develop gradually over time. This means they can start as a dull ache in the heel, and gradually progress to significant pain.
Interestingly, while plantar fasciitis used to be fairly rare in young children, we have seen it present in kids as early as 12 years old in recent years. With competitive sport being encouraged and participated in more and more at a young age, the fascia is being overused and damaged in some children.
What is the best treatment for heel pain?
Determining the best treatment for heel pain very much depends on the cause. When it comes to adult heel pain, however, one treatment has come out on top: shockwave, otherwise known as radial pressure wave therapy. And yes – it’s available here at Marlborough Podiatry!
Shockwave treatment has repeatedly proven in studies to have both a high success rate in treating plantar fasciitis, as well as patient satisfaction after its use,,. According to Podiatry Today, “of the treatment modalities that have been evaluated with robust research designs, extracorporeal shockwave therapy (ESWT) has arguably the best evidence to date” in the medium and long-term. It has also been found to achieve significant reductions in pain and significant improvement in both function and a patient’s quality of life when it comes to Achilles pain.
When it comes to children’s heel pain and Sever’s disease, the goal of the treatment is very different – to reduce the irritation and strain on the vulnerable growth plate. We do this successfully using a combination of custom foot orthotics, ensuring that your child is wearing the right footwear, as well as managing and encouraging the lengthening of the Achilles tendon itself.
Truthfully, every treatment we recommend and plan for you is done following a comprehensive assessment of your feet and legs, so we always select the right treatment for you that is best suited to your work, lifestyle, medical conditions – as well as being geared to help you get the best results.
World-class podiatry care for the whole family
Our podiatry team is experienced in treating lower limb pains and problems for the whole family – from kids to grandparents. We’re parents too – so we understand how important the right and timely care is for your little one. Book your appointment online here or call us on (03) 972 2927
