In developing children, the heel bone known as the calcaneus contains a growth plate. Next to this growth plate is another bone called the apophysis of the calcaneus. The growth plate sits in between the calcaneus and its apophysis. The medical term for this growth plate is physis. As a child grows, calcium is deposited into this area and new bone is formed at the growth plate. As this is a developing area; repetitive stress through increased physical activity can cause painful inflammation in the area of the growth plate, within the heel bone and around the ankle. This is known as calcaneal apophysitis i.e. growing pains in ankles.
Why Is My Child Suffering from Growing Pains in Their Ankles?
Every child has a growth plate in their heel bone therefore, many children undergo growing pains in their ankles. Usually, growth pain occurs if:
- Your child has undergone a growth spurt/s. This may not always be very obvious to a parent as they see their child daily. An easy way to establish if your child has had a growth spurt is to check for increases in their school uniform sizing or checking the length of their pants or dresses and comparing it to the previous 6 months.
- There is an increase in physical activity. If your child takes up a new sport, participates in a large range of sports or increases their training sessions/ load.
Diagnosing Growing Pains
Your podiatrist can help establish if your child is undergoing growth pain. The feet are a complex structure which means there are a lot of possible causes of pain. Your podiatrist may complete a range of tests such as muscle strength testing, gait analysis and joint mobility tests. They may also ask you a range of questions to establish if your child has the symptoms of growing pains or if they are experiencing a different pathology. These questions may include:
- How old is your child?
- How much activity are they currently completing?
- Have they had a recent growth spurt?
- When did the pain start?
- What makes the pain better or worse?
- Does the pain keep you awake?
- Do you have the pain the morning or in the late afternoon?
Further to this, they may delve deeper into the kind of pain your child is undergoing. Additionally, your podiatrist will conduct a test known as the squeeze test. This involves squeezing your child’s ankles to see if pain is elicited. Your podiatrist will then use this information to establish a diagnosis and a management plan.
How Long Will The Growing Pains Last?
The duration of growing pain in the ankles is dependent on a large variety of individual factors. Each individual’s anatomy, physical activity levels and body build is different hence healing time is unique too.
Generally, growing pains tend to resolve once the child is past large periods of growth. Overall, it is a self-limiting condition. This means the pain will eventually resolve on its own with or without intervention. Around the age of mid adolescence , approximately around 14 years of age, the growth plate is ossified (closed) and will not cause further pain.
What Can I Do To Manage The Pain?
There are many options to aid the management of growing pain. These options include:
- Changing footwear to more supportive shoes. Changing footwear to more supportive shoes can decrease the stress placed on feet to enable a reduction in pain
- A stretching and strengthening routine. Utilising physical therapy throughout the day can positively impact the range of motion to enable pain reduction. Adding on specific exercises can be utilised to target muscle strength and coordination.
- Using RICE therapy. RICE stands for rest, ice, compression and elevation. Any one or all four treatment options can be utilised to manage growing pains.
- Utilising shoe inserts. There are a range of different options to help offload and realign feet. These may include small devices such as heel lifts to completely customised options such as orthotics. Shoe inserts work to further offload muscles or specifically painful areas to provide pain relief.
- Decreasing activity levels. A reduction in activity levels aids the reduction of growing pains. If reducing activity levels is not possible, the options discussed above can be utilised while continuing to be physically active.
- For parents, management options for their children at home can include:
- Encouraging your children to undertake gentle stretches through out the day, especially before or after exercise.
- Completing stretches with your children
- Setting different stretches as small games for your children to complete. An example of this may include completing lunges to and from the dinner table when setting up
- Using ice packs on the heel after physical activity or allowing your children to prop their feet up with some pillows underneath
Other Causes of Growing Pains in Ankles
Besides the primary causes of growing pains, other causes may include:
- Lower limb posture – very flat feet which causes feet rolling in, otherwise known as hyper pronation places increased stress on the foot and leg muscles. Children with flat feet are more prone to developing growing pains in the heel.
- Tight muscles – decreased range of motion in muscles can place more stress on the tendons, bones and joints of the feet. This may also cause more aching muscles or premature fatigue though muscular tiredness.
- Activities involving increased load on the heel bone – certain sports place more stress on the heel bone compared to others. Activities such as running, jumping and hopping on feet can further aggravate the growth plate. Swimming and cycling are options children can undertake to reduce load on the growth plates and continue to keep active.
When To See A Professional?
It is important to see your podiatrist if the pain is ongoing and persistent. Your podiatrist can assess, diagnose, provide treatment options or direct you in the right direction.
It is important to seek medical attention if the pain:
- Does not resolve with rest
- There is an associated fever
- It causes limping, severe pain is present or leg pain is also present
- Wakes the child up at night or continues to be present in the morning
- The pain occurred after a injury
This may indicate the pain is due to an injury or a different condition which requires medical intervention.