Many have noted how plantar fasciitis, a condition that causes heel pain has become prevalent among certain segments of the population. It’s especially common in older people. Studies have looked into incidence reports involving soldiers and wait staff in the food and service industries. Athletes and runners are also more susceptible to this condition. But what about plantar fasciitis in children? How often does it happen?
Children and Heel Pain
Children can be a hardy bunch, but they’re also relatively fragile and can get injured very easily. Some aches that adults pass off as inconsequential may feel more serious to a child. Children often complain about pain under their heels, and if this is the case for your child, you should not simply shrug it off.
Heel pain is a symptom of an underlying problem and it can be caused by a disease or an injury. When it happens to children, parents should be warned that a child may need more attention than a kiss and a hug to make them feel better.
For kids, the problems associated with heel pain may come with any of the following conditions:
- The pain is at the bottom or at the back of the heel.
- The pain may cause the child to limp.
- The child may also decide to walk with their toes instead, to avoid putting weight on the heel.
- They may also find it more difficult to participate in the games they play with other children, such as playing tag.
Adult versus Pediatric Heel Pain
When an adult experiences pain under the heel, it is a pretty good guess to think that plantar fasciitis is the culprit. The condition occurs when you have an inflamed plantar fascia, which is a band of tissues that run along the bottom of your foot from the heel to the toes.
When you feel pain due to an inflamed plantar fascia, it can be sharp and intense, and this pain is especially evident in the morning, after a full night’s rest or after sitting for extensively long periods. But when you walk around a bit (especially when you wear shoes with proper cushioning and arch support), the pain usually subsides.
But when children have heel pain, the pain doesn’t go away after walking or stretching. You don’t even want your children to walk around when they have heel pain, because that can actually make the pain worse.
Heel pain is actually quite common among kids, because their feet are still growing. A child’s heel bone won’t fully develop until they’re at least 14 years old, and some take longer. Before that time, children grow new bone at the growth plate, which is a weak area found at the back of the heel. And that’s really the most common cause of heel pain in children: too much stress in the growth plate.
Diagnosing Heel Pain in Children
Heel pain in kids can have a number of possible causes, and it is not always easy to determine which one is the culprit. The most common cause is actually a condition called Sever’s disease, medically known as calcaneal apophysitis. It is due to the inflammation of the growth plate in the heel brought about by repetitive stress and muscle strain.
Other suspects include Tendo-Achilles bursitis (inflammation of the bursa), various overuse syndromes (which include Achilles tendonitis and pediatric plantar fasciitis), and fractures.
You’ll suspect child plantar fasciitis, however, if your son or daughter has the following symptoms:
- They experience pain under the heel, and it’s really bad taking the few first steps after they’ve been resting, sitting, or sleeping.
- The pain becomes worse at the end of the day.
- When they’re running around, they feel the pain under the heel and across the arch.
- They feel pain when they walk on very hard surfaces, like the bathroom floor and cement roads.
You don’t have to wait for them to confirm these symptoms before you take your child to a doctor. You’re better off seeing a specialist like a podiatrist, who specializes in these conditions. The podiatrist will take a comprehensive medical history, perform a physical examination, and analyze your child’s gait.
Additional tests may be needed and these include:
- An assessment of your child’s foot posture
- Pain provocation tests
- Tests for range of motion and joint flexibility
- Footwear assessment
- Strength testing for foot and leg muscles
- A comprehensive assessment for biomechanics and gait analysis
If It Really is Plantar Fasciitis, What Caused It?
While plantar fasciitis is not the most common cause of heel pain in kids, it still accounts for about 8.2% of pediatric musculoskeletal complaints. In very young athletes, it rarely occurs by itself, and most of the time you’ll also find that Sever’s disease is also part of the problem. But adolescent plantar fasciitis can occur exclusively if your child has fully developed their heel bone or calcaneus.
In adults, plantar fasciitis is common among overweight runners. The combination of pounding the feet over hard roads and carrying excess pounds can really strain the plantar fascia, and that’s especially true when you also add improper running shoes. For children, it’s much the same—there may be several factors that contributed to the medical condition.
- It may be caused by abnormal foot posture, which a doctor can confirm upon examination. This can be flat feet, or overpronated feet that roll in too much. This can overload your child’s plantar fascia, which then results in inflammation and pain.
- Improper footwear can also be the culprit, and that’s especially true when children use overly flexible shoes.
- Joint hypermobility can also be a problem. Children who have overly flexible joints are more prone to arch strain, which can then lead to plantar fasciitis.
- Childhood obesity is also increasingly part of the problem. Over the past 30 years, obesity has more than doubled in children. For adolescents, the rate has quadrupled. In 212, the CDC reported that up to a third of all children are overweight or obese.
This is a problem for children, because the extra weight can stress out the soft tissues that support the child’s feet.
- It may also be calf muscle tightness, which means the calf muscle wasn’t stretched properly before the children engaged in vigorous play.
- An increase in the sports training routines can also be a factor, as the extra physical activity may have overburdened the capability of the fascia.
In general, surgical options are rarely necessary. Usually, the treatment just depends on how painful the medical condition is for the child.
- If the pain is only mild, then affected children are advised to minimize or even stop any activity that may be causing the pain in the fascia area. Your doctor may also recommend the use of temporary shoe inserts especially for school shoes, as these devices can soften the impact on their heel when they’re walking or running.
- If the pain is moderate, additional treatments are usually necessary aside from wearing shoe inserts and rest. Orthotic devices may be used to support the foot more properly. Physical therapy, including massages and stretching, may also be recommended. Your doctor may also prescribe non-steroidal anti-inflammatory drugs that are safe for children.
- If the pain is severe, then your child may have to use crutches so they won’t put weight on the affected foot. The foot may be put in a cast to encourage healing while remaining completely immobilized.
How to Prevent Heel Pain in Children
If you’re a parent, plantar fasciitis is actually far down the list of medical problems you should be worried about. But in general you should make an effort to at least prevent heel pain in children. This will save your child from having to deal with excruciating pain. Some of the most effective preventive measures are as follows:
- Help your child stay fit. This means you need to keep them from eating too much junk food, and you also have to get all those calorie-rich foods out of reach. Encourage them to eat veggies, fruits, and whole grain products, with lean meat, non-fat dairy, and reasonable serving portions.
- Make sure you pick the right pairs of shoes that actually offer sufficient support for your child’s feet. Their shoes should be appropriate for their play activities.
- You may want to limit the time your child wears cleated athletic shoes. These can be too hard and unforgiving on children’s feet.
- Don’t force your children to engage in activities that are still beyond their abilities.
Despite your preventive measures there’s always a chance that your child will eventually experience pain in the heel again. When that happens, don’t assume that the plantar fasciitis has returned. It may be a different cause this time. To get a proper diagnosis and treatment, you need to see a doctor.