Blog by Alicia James

Heel pain in children is reported as one of the most common presenting foot related concerns to health professionals. The oddly shaped bone (calcaneus) is anatomically surrounded by complex structures that both secure the foot and enable mobility of the ankle.

We are often quick to jump to calcaneal apophysitis (Sever’s Disease*) and or Achilles tendinopathy when presenting with kids who have heel pain. Don’t forget though, there’s so much more to this keystone area of the foot.

Calcaneal apophysitis is diagnosed using clinical assessments e.g. child presenting between the ages of 8-14 years with a positive “squeeze test” (medial and lateral compression of the calcaneus). Please remember to think far broader!

A continuous dull ache, night pain, without inflammation could indicate a fracture, a benign tumour or even worse, malignancy. A through assessment ensures you have assessed range of motion and any subsequent restriction, inflammation, pain on activity, and pain on first step are all considered and the diagnosis is true to the presenting concern.

Your ability to consider all possible differential diagnosis for one of the most commonly presenting conditions will ensure you provide a personalised treatment pathway for the young person sitting in front of you.

While sitting in an airport in transit with another Children’s Podiatry Consultant, we brainstormed and developed a mind map for what we thought were all the common and not so common presentations of heel pain in kids, plus their associated common presentation or symptoms. Please feel free to contact us if you feel additional conditions need to be added.

* Sever’s Disease- Please note we would like to remind you to utilise terminology that is universal across all health professionals; preference is the terminology calcaneal apophysitis. #NOTADISEASE