Why is my 11-year-old limping on the soccer field? Should I let him keep playing? Why is he having pain, and what can we do to make it go away?
These are some of the most common questions I get asked by parents who have children playing competitive sports. Heel pain in children between ages 8 and 13 that happens during sports without any history of injury is often from Sever’s disease.
Sever’s disease is an overuse injury to the growth plate of the heel bone. When older children and adolescents have growth spurts, the long bones grow rapidly. The muscles and tendons, however, continue to grow at the same rate. Therefore, the muscles become very tight. In active children, the tight calf muscles and Achilles tendon pull repetitively at the growth plate in the heel when they run or jump. This causes inflammation and pain along the growth plate.
Pain along the growth plate in the heel is a self-limited condition. The pain will resolve once the growth plate closes, typically within six months. Sometimes, however, it can last up to two years. It is safe to allow your son to continue playing soccer. To make the pain better, he can take Ibuprofen before playing, and ice the heel afterward. Using a gel heel lift in his cleats can also help lessen the pain.
The most important thing to help alleviate the pain is to stretch the tight muscles. He should do calf, quadriceps and hamstring stretches at least twice each day. Each stretch needs to be held for 20-30 seconds. If stretching on his own isn’t enough to treat the pain, it can help to work with an athletic trainer or physical therapist. If the pain persists, your son’s doctor may want to get X-rays to make sure there are no other causes of his pain. If these are normal, you can get an order to schedule therapy.
The pain can recur when your son goes through growth spurts, and he should be sure to keep up with his stretching. Sever’s disease can involve both heels. Many active children can also have knee pain with sports. This can be from a similar, more common condition known as Osgood-Schlatter syndrome. Osgood-Schlatter refers to pain on the front of the shin bone where there is another growth plate. The patella tendon inserts on this growth plate, and muscular tightness can cause pain and inflammation. Often, children can develop a bony bump over the front of the shin at the site of the pain. Treatment is similar, with ice, Ibuprofen, and stretching at least twice daily.
Marjorie Delo, MD, CAQSM, is a fellowship trained primary care sports medicine physician at HFM Lakeshore Orthopaedics.