Address pain early, avoid long recovery.  
 

The American College of Foot and Ankle Surgeons stresses that athletes should never “play through the pain” in their feet. Left untreated, heel pain can lead to difficulty in walking that will require complicated therapy.

The number of pediatric patients reporting heel pain increases with fall and winter sports seasons. Obesity is emerging as another prominent cause of heel pain—even with students in physical education class activities, says Karl Collins, DPM, FACFAS, a St. Louis-based foot and ankle surgeon.

The good news is that kids are good healers, and treatment may be simple if it is done quickly.

“Put in a little time to address the problem early because if you wait, you might be in a cast or boot later for a long time,” Dr. Collins says.

Kids undergoing growth spurts are especially susceptible to heel pain starting at age eight until around age 13 for girls and age 15 for boys. The source of the pain is usually the growth plate of the heel bone, a strip of soft tissue where new bone is forming to accommodate adolescents’ lengthening feet. Overuse, repeated pounding or excessive force on the Achilles tendon can cause inflammation and pain.

For many teenagers, the growth plate has completely closed, and heel pain is caused by other conditions, such as plantar fasciitis, tendonitis, bursitis, bone bruises or fractures.

Sometimes, the simple RICE strategy—Rest, Ice, Compression, Elevation—resolves pain, but when healing does not happen soon, it is time for clinical evaluation. Anti-inflammatory medications, physical therapy or other treatments tailored for patients may be necessary. Trauma injury to the foot requires immediate consultation.

“People have a tendency to give it time and see if the pain goes away on its own, and sometimes that happens. But if symptoms persist, it’s time to see a specialist to make sure the foot is healing properly and to avoid complications,” said Tim Swartz, DPM, FACFAS, a Maryland-based foot and ankle surgeon.

Dr. Swartz said parents often bring their kids to the pediatrician or the emergency room first but need to follow up with a foot and ankle surgeon. With extensive experience in foot and ankle therapies, foot and ankle surgeons are uniquely qualified to diagnose and treat foot problems in young people through examination and imaging beyond basic x-rays, which do not always reveal the cause of the pain.

Preparation and recognition of warning signs can help prevent or reduce the severity of heel pain.

Supportive shoes are a must, but it is not always obvious when to switch shoes or to adapt them for the best fit. Consider these guidelines:

• Use inserts to raise the heel, especially in flat-footed cleats.
• Discard shoes that caused pain. Do not use them for another sport.
• Wear well-constructed shoes designed for specific sports.
• Switch cleats often because they are not supportive shoes.
   

Do not skip warm-up or cool-down exercises, Dr. Swartz added. Stretching helps prevent heel pain, especially when sports call for explosive sprints that pull quickly on tendons.

Several things should tip parents off that their child needs attention, including limping, complaining, walking on toes and pain the morning after a game. Parents should never push their children to play when their feet hurt, even if it is “the big game.”

Dr. Collins said one tenet always applies: “Foot pain is never normal, and you should never play when you are in pain.”