Time to discuss a clinical topic Section

11 year old with heel pain

I no longer see children at my Spire clinic as we are not licensed for surgical treatment under 16 years. This has been the case for some ten years. Having spent a good deal of my career both teaching and treating children, it is always nice to meet a young patient where I can give advice and reassurance. Young Jo was a keen rugby player and as his mother recounted, he is active at some sports or other most days of the week. His heel pain had come on and was undoubtedly made worse by his physical activities. My practise deals with some 8-12% heel pain and so in a child you might think that it might not be different to an adult. In fact 11-14 year olds, more so in boys, suffer apophysitis and this is something adults are not troubled with. This is a self curing condition as I explained to Jo’s mum, who seemed perhaps surprised that this had not been explained to her before. She was in fact doing the right thing by lifting his heel with an insert to take the tension off the tendo achilles.  I explained the problem arises because the heel bone is not fully mature and a small part of the heel can be pulled against the main body by the activity of the tendo achilles. When growth has ceased  around 12- 14 years, the location becomes stable and can take more activity. Symptoms can last for 6 months. The condition does not need treatment usually and is often inappropriately referred to as Sever’s disease. It is not a disease but a common growth pain. The cure is to wait and reduce tension around the tendon. I cannot overcome Jo’s natural frustrations as he will have to modify his physical activities for a while, but as the summer holidays creep up on children, maybe this is a good time to find other things to do, although being glued to the computer may not be the ideal preference for most parents. Killing aliens might be preferable to being killed by pain! Good luck Jo.

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