Heel Pain in Children with Wil Seto

Mark: Hi, it's Mark Bossert. I'm here with Wil Seto of Insync Physio in Vancouver. And we're going to talk about something we haven't talked about this before. Heel pain in children. How are you doing, Wil? 

Wil: Yeah, I'm doing good, thanks. 

Mark: So what causes children to have heel pain and what are the symptoms?

Wil: Yeah, so essentially heel pain in children and this is a condition called Severs Disease. And so the reason, it's called Severs is because it was actually a term coined by a doctor back in 1912. His name was James Warren Sever. So Sever's disease is, when you have this issue in kids where their bones are not fully mature, what happens is that in that attachment point where the tendon is the Achilles tendon you know, basically because of the repetition and the overuse and the overload or the microtrauma where it attaches, it starts to traction so much so that it basically starts to kind of pull off and cause this inflammatory process that's right at the detachment point.

And so in some ways, if you really think about the actual, like, sort of mechanism and what's actually going on in there, it's like tiny little micro fractures that is pulling it off the bone kind of thing. 

Mark: So is this associated typically with a lot of running?

Wil: Yeah, just basically a lot of overuse. Running is definitely a huge one. Anything that has repeated impact pressure you know, like on the heel. And the reason why too, is because like I was saying, it's not like the bone is not fully formed and developed. And so bone is kind of more, like when it's mature in an adult, fully grown person, it's definitely a lot harder and it's a different makeup versus when in a child, it's more cartilage like, so they call that a fibro cartilage, which is a lot softer.

And so this is quite typical around when in a child who's seven to nine years old because the bone isn't fused yet. So the Achilles tendon, which inserts onto that lower portion into the heel, there's the pull off of it. And so the pulling, like the growth plate, and because of that high stress from whether it's running, it's that impact loading essentially.

Mark: No worries. So dancing jumping of any kind, like skipping rope or anything that's going to load that heel part of the foot could be a cause of this? Like doing a lot of something at a younger age? 

Wil: Yeah, exactly. And how it's usually presented as a, again this is what's actually really good for, like, in terms of having it assessed because they usually don't have any pain in the morning.

So when you look at people that have heel pain, like as a grown up, you know, when bones are fully mature, it's like looking at, Oh, I got this heel pain. You do your internet search or whatever, and you look for that kind of symptomology and they find that it's like a plantar fasciitis. Well, plantar fasciitis is when you usually have pain in the morning. And so there's all these things like where some things are similar and some things are not, and then we need to assess it too as well.

You know, and obviously you're gonna have more pain as you do more activity and weight bearing on it. There's usually no swelling in there as well, but the pain is increased with those activities. And it can also be associated with a foot malalignment and whatnot. And then typical too is, like, you know, your child will have more limping at the end of whatever they're doing. And there'll be limited range of motion as well. 

The biggest thing with this is that rest is really important, and then initiating, like, physiotherapy. If it's assessed properly, will be able to influence that healing process even more. 

Mark: What is the typical course of treatment?

Wil: Well, the first thing is that if they're going to be engaging, like, I'll give you an example. We have a child whose father brought him in to see one of our physios, and he's trying out for a competitive soccer team. And I think he's only 12. And that's usually the typical age is 10 to 12, and it's usually more boys.

First thing is, you gotta let him rest. So you gotta, like, discontinue the running. And it's hard, you know, the kid wants to play and the dad wants to get him going in the program. It's difficult. But one of the biggest things you got to limit that activity. Discontinue the thing that's going to make it worse. And typically, like for kids, that's very important. Very important. But then it's also after we initiate that rest period for if it's like a week, to at least when they don't have any more pain. Then how do we progress them back on a program that is actually safe and is gradually getting them stronger without re aggravating this.

Mark: So what's the downstream effect? If they don't rest, what can happen? 

Wil: Yeah, that's a good question. So, there's quite a few things actually. So if you don't rest, you can actually end up getting things that can cause like a potential fracture. You know, and basically as you're looking at what's happening with this syndrome, if you're not allowing it to heal, that's huge. And that can affect, like, as the little person grows and they're going to have a sequela event. Because then if they have a fracture there, they're going to be having pain all the time. And then they're going to compensate, and their body's going to maladapt to that.

And that's huge. I mean, I can't stress how big that is. In terms of making sure that this is really diagnosed properly because there's also a lot of other things that you know, when you look at the syndrome or this disease, that you also want to rule out other things going on in there.

So when you have this and you look at the presentation of it, and you know what you can do, and like long term effects of the actual tendon integrity and also the muscle imbalances. Those are huge. But you also have to differentiate is this really a Severs or is this just like a heel spur. Or is this like just like an issue of a fat pad thing going on, or maybe it's just a bit of Achilles overuse, it could be.

We have to diagnose it properly. Usually more in boys than girls, like I was saying, so you have your kid that wants to get back into competitive sports you know, or doing something more active, rather, and be less competitive. So it's so important to be able to get that accurate diagnosis and treatment plan, because then it's just, there's the go down that rabbit hole of just really having these complications. 

And another one is Osteomyelitis, which is basically you can get an infection. I mean, that's kind of a worst case scenario, an infection of that area. And then, like I was just saying, then that would lead to just more altered gait patterns and then maybe a prolonged limp, ultimately. Prolonged pain and discomfort, which can lead to a whole series of things.

Mark: If you need to get accurate diagnosis for any injury or if your child is having some heel pain, the guys to see are Insync Physio. You can reach them on their website, insyncphysio.com to book, or you can call the Vancouver office at (604) 566-9716. Or you can call the North Burnaby office at (604) 298-4878. Thanks, Wil. 

Wil: Thanks, Mark.