Calcaneal apophysitis is the most common cause of heel pain in the adolescent population. It most commonly occurs in active boys, but girls can be equally affected. It usually occurs between the ages of 6-13 years old.

Causes

Pain on the sides or bottom of the heel, which is aggravated by running jumping and squatting. Since the growth plate in the heel is still open at this age, the back portion of the heel is prone to movement. Pain is secondary to microtrauma from traction of the Achilles tendon and the plantar fascia as they exert forces on the back (posterior) aspect of the heel bone (calcaneus). The main cause is a combination of increased activities and rapid growth during adolescence.

Treatment

X-rays are usually not indicated. The treatment should focus on temporarily limiting/reducing activities and decreasing the traction of the Achilles tendon and plantar fascia, i.e. with heel lifts, visco-elastic heel cups, temporary taping and/or orthotics. Ice and pediatric anti-inflammatories can be used if the symptoms are acute.

Prevention

Really none. Once the symptoms resolve, the patient should be able to gradually return to activities.