What Causes Pain in Children & How Is It Treated?

Is your child complaining of foot pain? There are many reasons we see children at Foot Centre Group- from ingrown toenails, warts, intoeing, toe walking, flat feet, leg pain, gait analysis for concerns of lower limb pain and heel pain. These are the top reasons we see children in clinics. Children will  generally advise you of foot pain or any complaints of pain in one or both lower limbs.  The foot pain or discomfort can be  located at the back of the heel (Achilles tendon), forefoot, toenails, ankles, shin and other parts of the foot and lower limb. The most common cause that we see children in clinics is due to heel pain. In children as is very important to get a proper diagnosis as a child’s foot isn’t just a small adult foot.

Most Likely Causes of Pain in Children

Severs:

The most common cause of heel pain in children is a condition called Calcaneal Apophysitis (Sever’s Disease) this is located on at the growth plate on the back of the heel.

This is usually present in kids who grow rapidly and are physically active. Severs is most common between the ages of 8-15, however it can occur outside of this age range. It is common in both girls and boys however there is a slightly higher occurrence rate in boys.

The exact cause of Calcaneal Apophysitis ( Sever’s Disease) is unknown. However we do know that it is caused by multiple factors. This includes

  • Rapid growth
  • Increase in activity levels
  • Change in activity type
  • Increased body weight
  • Decreased muscle strength in the foot and ankle.
  • Tight calf muscles

Symptoms to Look Out For

  • Heel pain during physical exercise, especially activities that require running or jumping
  • Worsening of pain after exercise
  • Limping – often in the morning, or during or after sport
  • Tendency to tiptoe.
  • Walking of the tips of the toes
  • Difficulty running, jumping, or participating in usual activities or sports
  • Pain when the sides of the heel are squeezed
  • Tiredness

Calcaneal Apophysitis (Sever’s disease) is generally a self-limiting condition. This means that symptoms often ease with time and intervention. Podiatrist’s can help manage the symptoms through:

  • education on how to self-manage the symptoms and flare-ups
  • activity modification – reducing the amount of activity but not stopping the child from participating.
  • load management – at first this may include a period of decreased or modified (changed) load. However, load is important for the tendon, heel bone and apophysis, so after the initial flare, load needs to be managed to ensure these remain healthy.
  • avoiding stretches and ‘eccentric’ exercises (such as lowering your heel over a step or jumping or hopping) in the initial phase
  • use of a heel raise – used in any shoes causing the problem, to take the pressure off the apophysis and tendon
  • support for any biomechanical factors that are contributing to the pain – particularly around the foot. For example, foot taping or doing exercises to improve neuromuscular control around the foot.
  • orthotics – these may help relieve some biomechanical symptoms
  • heat packs – applying heat packs to the back of the heels for around 15 minutes after physical activity when a flare-up occurs
  • medication – pain-relieving medication such as ibuprofen/panadol may help to reduce the discomfort.

As the apophysis (growth plate) takes two years to mature (sometimes longer), there may be flare-ups from time to time triggered by growth spurts, changes in sporting activities, increased intensity, changes in footwear or changes in surface.

Diagnosis:

Our podiatrist  can diagnose Sever’s disease by asking the young person to describe their symptoms, history of pain and by conducting a physical examination. In some rare instances, medical imaging may be required to rule out other causes of heel pain.

When an apophysis(growth plate) is active it is changing from cartilage to bone, the normal x-ray appearance will vary from no bony tissue to small deposits of bone to a fully united bony tendon attachment. However, there is usually no difference in what can be seen in a heel x-ray of a child experiencing Sever’s disease-related pain, and that of another child of the same age who is pain free. For this reason, x-rays are generally not used to diagnose Sever’s disease.

Bursitis

Bursitis is inflammation occurring around the bursae located at the back of the heel near where the achilles inserts. Bursae are small sacs that contain fluid to lubricate moving parts such as joints and muscles. This is not a super common cause of heel pain in children however always needs to be considered. Bursitis at the heel in children generally becomes inflamed due to impact injury, overuse injury and tight shoes.

Heel fracture

There are two main types of fracture that can occur around the heel bone. This includes:

  • Stress fracture which is generally not common in children however can occur. This may occur due to a sudden increase in activity levels in conjunction with other factors, such as nutrition deficits and hormone levels. A stress fracture is not a complete break; it is a micro trauma event where the bone has not been able to repair itself at the rate that it naturally breaks it down, leading to a stress reaction or fracture.
  • Heel fracture – can occur due to sudden trauma, there will be an event that they would remember or report. The pain will be constant and most likely unable to bear weight. Conservative treatment includes ice, rest, immobilisation with use of a cast or splint, and pain medications. Children should avoid participation in activities or sports until the bone is completely healed. Strength and conditioning can help during and after the healing process and assist in a gradual return to activity.

Juvenile Idiopathic Arthritis

Juvenile Idiopathic Arthritis characterises to describe all the joint conditions that affects kids and teens. Typically it  causes joint pain and inflammation in the ankles and other joints of the body.  JIA types are autoimmune or autoinflammatory diseases. That means the immune system, which is supposed to fight invaders like germs and viruses, gets confused and attacks the body’s cells and tissues. This causes the body to release inflammatory chemicals that attack the synovium (tissue lining around a joint). It produces fluid that cushions joints and helps them move smoothly. An inflamed synovium may make a joint feel painful or tender, look red or swollen or difficult to move.  The word “idiopathic” means unknown, and researchers aren’t sure why kids develop JIA. They believe kids with JIA have certain genes that are activated by a virus, bacteria or other external factors. But there is no evidence that foods, toxins, allergies or lack of vitamins cause the disease.

Most children who suffer from Juvenile Idiopathic Arthritis have one or more of the following symptoms

  • Joint pain or stiffness; may get worse after waking up or staying in one position too long.
  • Red, swollen, tender or warm joints.
  • Feeling very tired or rundown (fatigue).
  • Blurry vision or dry, gritty eyes.
  • Rash.
  • Appetite loss.
  • High fever.

If Juvenile Idiopathic Arthritis inflammation goes unchecked, it can damage the lining that covers the ends of bones in a joint (cartilage), and the bones themselves.

Treatment

There is no cure for JIA but remission (little or no disease activity or symptoms) is possible.  Early aggressive treatment is key to getting the disease under control as quickly as possible.

The goals of JIA treatment are to:

  • Slow down or stop inflammation.
  • Relieve symptoms, control pain and improve quality of life.
  • Prevent joint damage.
  • Preserve joint function and mobility.
  • Reduce long-term health effects.
  • Achieve remission (little or no disease activity or symptoms).

Treatment for JIA varies depending on disease type and severity. A well-rounded plan includes medication, complementary therapies(strength and conditioning) and healthy lifestyle habits (activity, healthy eating,

If your child is suffering from heel pain and struggling to play, run and jump – book an appointment with one of our experienced podiatrists who can help your child return to sport and activity with minimal to no pain.

Ingrown toenails

Ingrown toenails are a very common condition that walks into every Podiatry clinic. This condition occurs when the side of the nail grows into the surrounding nail solci. This results in redness, swelling and pain. If left for too long, it can also result in infection. Ingrown toenails can occur in any of the nails, but it commonly occurs in the big toenail.

What causes ingrown toenails?

  • Incorrect cutting of your toenails
  • If you cut your toenail to short or curl/ taper your toenails inwards this encourages and causes the toenail to grow inwards into the skin of your toe resulting in the nail to lay under the skin and cause increased pressure allowing callus build up.
  • Naturally involuted (rounded/curved nail bed) or wide toe nail
  • Unfortunately genetics come into play with IGTN (thanks mum and dad!) and the main common reason is that your toenail naturally like to be round in towards the skin or very wide and this can cause the nail to become Ingrown and if left untreated can be an Infected toenail
  • Injury to your toenail:
  •  If you have had any trauma to your nail whether this is stubbing of the toenail/ toe, someone stepping on your nail, sport injury to the toe this can result in damage to the nail matrix changing the way that your nail grows out permanently and can cause the nail to naturally grow inwards.
  • Tearing, picking or biting your toenails
  • We tend to find a lot of kids, teenagers and adults tend to tear, pick or bite their nails instead of using proper nail clipper or scissors to cut them this can result in nail spike or splitting of the toenail  being left in the edge of the skin and resulting in an Ingrown toenail.
  • Tight fitting shoes
  • Ingrown toenails may occur due to wearing shoes that are too tight or too short and causing excess pressure place on the nail resulting in it changing direction and digging down into the skin
  • Medical issues – diabetes, immunosuppressed, psoriasis or Raynaud’s 
  • Unfortunately some medical conditions do increase the chance of Ingrown toenail and in particular infected Ingrown toenails

Foot and ankle injury

Sprains, tears, bruising, and breaks in your child’s foot or ankle need immediate attention. They should be properly diagnosed in order to receive the right care. That might include things you can do for her at home such as keeping the foot elevated, resting and icing it, helping them perform strengthening exercises. Even mild sprains can turn into lifelong foot problems if left untreated.

In toe walking or out toe walking

most toddlers who walk with their feet pointed inwards or with their feet pointed outwards will start to walk more straight by the time they turn 2 years old. If this does not correct itself by 2 years old or they are complaining about being in pain, an assessment by a Podiatrist is warranted.

Toe walking

Children who walk on their toes who can get their heels to the ground usually grow out of this phase. However, it is always good to have an assessment to make sure there are no underlying neurological issues that could have been missed.

The most important thing you can do if your child has foot pain is to take it seriously. Make sure you see a Foot Centre Group podiatrist as soon as possible if your child suffers from severe pain or anything that requires more than a band-aid and a hug.

At Foot Centre Group, we believe your child should not have to suffer foot or ankle pain. We believe they should get the right treatment at the right time, and see results as quickly as possible. We see our patients as individuals, listen carefully, and offer customized treatment plans.

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