Heel Pain in Children and Adolescents

Heel pain is a very common symptom in adults. Occasionally, however, a child or adolescent may experience heel pain.

When a child complains of heel pain, it is often thought to be "growing pains," a normal phenomenon during childhood and adolescent growth spurts. Growing pains are a simple way of describing mild and short-lived pain, usually in the legs where muscle attaches to bone. During growth spurts, a bone may grow faster than muscle, resulting in muscle or tendon strain that causes mild pain or discomfort. It tends to occur late in the day or at night, after a busy day of activity.

Other possible causes of heel pain in children and adolescents include:

• Calcaneal apophysitis: The calcaneus, also known as the heel bone, has an area where growth of the bone occurs (known as an apophysis). It is located at the back of the heel bone, near where the Achilles tendon attaches. This growth plate is subject to pulling and tension from the tendon, which can lead to a painful heel.

Calcaneal apophysitis, which is also called Sever's disease, usually occurs between the ages of 8 and 14. The condition can be aggravated by increased activity, especially if there has been strain on the Achilles tendon from such activities as jumping or sprinting. Examples include heel pain from soccer and basketball.

X-ray image of a child's heel bone growth plate.

• Achilles tendonitis: Like calcaneal apophysitis, Achilles tendonitis is brought on by strain on the Achilles tendon, either by increased activity or tightness of the calf muscles, which kids commonly experience during growth spurts. The tendon is painful with activity and painful to the touch.


• Bursitis: Bursitis can also cause pain near where the Achilles tendon attaches to the heel bone. Bursitis is inflammation of a bursa, which is a pocket of fluid adjacent to the tendon. Bursitis is caused by tendon strain or irritation of the tendon from rubbing against a tight shoe.

Image of a bursa.

• Plantar fasciitis: Pain on the bottom of the heel may be caused by plantar fasciitis. The condition is caused by inflammation on the underside of the heel bone, where a band of connective tissue called the plantar fascia attaches. Plantar fasciitis is often caused or aggravated by problems with foot function, such as flat feet or high-arched feet.

Image of the Achilles tendon and plantar fascia.

What all of these conditions have in common is that they are caused by physical stress on the feet. Once a diagnosis has been made, the treatment plan will likely involve rest and daily stretching of the ankle and foot. If structural or functional problems with a child's feet are contributing to the heel pain, Dr. Raymond DiPretoro may prescribe or recommend shoe orthotics. An ankle brace or support may also be prescribed.

Other Less Common Causes of Heel Pain

Seek a medical evaluation if treatment for the common causes of heel pain does not result in improvement.

• Rheumatic - Inflammatory conditions such as juvenile rheumatoid arthritis and juvenile spondylarthropathies can cause heel pain. The juvenile spondylarthropathiesinclude reactive arthritis, psoriatic arthritis and ankylosing spondylitis.
• Congenital bone fusions, also known as tarsal coalitions
• Bone fractures
• Ulcerative colitis and Crohn's disease
• Tumors or bone cysts -- rare causes of pain that are diagnosed by X-ray or other imaging study

Sweaty Feet (Hyperhydrosis)

Wearing the correct socks is crucial—many socks now have special properties that wick moisture away from your feet and prevent bacteria from growing.

Did you know that in normal situations, your feet put out more than 1⁄2 cup of sweat per day? Try pouring that into your shoe. It's no wonder that problems such as sweaty and smelly feet are so prevalent.

There are more sweat glands per inch of our feet than anywhere else in the body, and their function is to keep the skin moist and therefore supple. They secrete all the time, not just in response to heat or exercise, as elsewhere in the body.

Some people just put out more sweat than average. This can lead to many problems, including athlete's foot, blisters and just plain discomfort. An added problem which often accompanies sweaty feet is foot odor. This is caused by bacteria on the skin breaking the sweat down, which releases an offensive smell.

Luckily, there are many treatments available to treat and prevent hyperhydrosis.

Possible Causes

Sweaty feet can be caused by stress on the foot. This may be due to a structural problem, or because the foot is under strain or tired—for example, when you've been standing on your feet all day.

Hot weather can make matters worse, although sweaty feet are a problem throughout the year.  Sweaty feet can also be an inherited condition.

In adolescents, sweaty feet are probably caused by over-active sweat glands triggered by changing hormonal levels in the body. As the sweat glands on the soles of the feet (and the palms of the hand) respond mostly to emotion, mental or emotional stress is a common cause.

What to do

Simple hygiene is usually effective in dealing with sweaty feet. Try the following recommendations:

Daily foot hygiene

• Wash your feet in the morning and evening with warm soapy water (use an anti-bacterial soap if odor is present). Avoid hot water, which may make you sweat more. After washing, dip your feet in cold water (do not do this if you have an existing circulatory condition).
• Dry feet thoroughly with a coarse towel.
• Apply an astringent like surgical spirit, and then lightly dust with talcum powder.
• Change your socks or stockings at least once a day.
• Rotate your footwear—try not to wear the same pair of shoes daily. Shoes don't dry out overnight. They may need a longer period of time.

Shoes

Careful consideration of footwear and socks is essential. Well-fitting shoes made of leather, which allow your feet to breathe, are best. Athletic shoes using nylon mesh for breathability are also recommended for sweaty feet.

Since a lot of sweat is absorbed by insoles or the uppers of shoes, don't wear the same pair every day, and allow them to dry out before wearing them again. Detachable insoles are also a good idea. 

Socks

Wearing the correct socks is crucial for people with hyperhydrosis. Sock technology has advanced tremendously over the past decade. Many socks now have special properties that wick moisture away from your feet and prevent bacteria from growing. 

See your foot health professional

If the above measures are not effective, you should see your podiatrist. They have a number of treatments available to help prevent sweaty feet problems. For example, there are prescription antiperspirants made especially for the feet.

Pregnancy Foot Pain

Wearing stable, properly fitting shoes is the most important thing you can do to prevent foot pain during pregnancy.

Complaints of foot pain are common during pregnancy, but they can usually be easily avoided or prevented with very conservative treatment.

According to our medical advisory committee, arch and heel pain and fatigue are the most common foot complaints seen in pregnant patients. They are most commonly due to a flattening of the foot. This flattening causes a “tugging” on the muscles and ligaments on the bottom of the foot, which leads to a condition called plantar fasciitis. There are several factors that occur during pregnancy that contribute to this flattening and lengthening of the foot.

• Wider gait
• Increased weight
• Forward shift of the center of body weight
• Relaxation of body ligaments

In order to prevent or limit these problems and reduce foot pain, it is important that pregnant women make sure that their feet are getting adequate support. You can get the support you need through the use of:

• Stable shoes
•  arch supports
• Custom prescription orthotics if necessary

The use of stable, properly fitting shoes is the most important tool in preventing foot pain during pregnancy. 

Most women do well with the correct shoes and appropriate arch supports. If these do not provide relief from your foot pain, you should talk with your podiatrist, who may find that you should be wearing a custom prescription orthotic to provide adequate support to your feet.

 Rheumatoid Arthritis of the Foot and Ankle

Rheumatoid arthritis (RA) is a systemic disease that attacks multiple joints throughout the body. About 90% of people with rheumatoid arthritis eventually develop symptoms related to the foot or ankle. Usually symptoms appear in the toes and forefeet first, then in the hindfeet or the back of the feet, and finally in the ankles. Other inflammatory types of arthritis that affect the foot and ankle include gout, ankylosing spondylitis, psoriatic arthritis, and Reiter's syndrome.

The exact cause of RA is unknown, but there are several theories. Some people may be more likely to develop RA because of their genes. However, it usually takes a chemical or environmental "trigger" to activate the disease. In RA, the body's immune system turns against itself. Instead of protecting the joints, the body produces substances that attack and inflame the joints.

Signs and Symptoms

The most common symptoms of RA in the foot are pain, swelling, and stiffness. Symptoms usually appear in several joints on both feet. You may feel pain in the joint or in the sole or ball of your foot. The joint may be warm and the way you walk may be affected. You may develop corns or bunions, and your toes can begin to curl and stiffen in positions called claw toe or hammer toe.

If your hindfoot (back of the foot) and ankle are affected, the bones may shift position. This can cause the long arch on the bottom of your foot to collapse (flatfoot), resulting in pain and difficulty walking.

Because RA affects your entire system, you may also feel feverish, tire easily, and lose your appetite. You may develop lumps near your joints, particularly around the elbow. 

Diagnosis

Sometimes arthritis symptoms in the foot are the first indication that you have RA. Your doctor will ask you about your medical history, occupation, and recreational activities, as well as any other persistent or previous conditions in your feet and legs. The appearance of symptoms in the same joint on both feet or in several joints is an indication that RA might be involved.

Your doctor will also request X-rays to see how much damage there is to the joints. Blood tests will show whether you are anemic or have an antibody called the rheumatoid factor, which is often present with RA. If you've already been diagnosed with RA, you and your doctor should be aware that the disease will probably spread to your feet and ankles. Watch for early signs such as swelling and foot pain. 

Treatment

Many people with RA can control their pain and the disease with medication and exercise. Some medications, such as aspirin or ibuprofen, help control pain. Others, including methotrexate, prednisone, sulfasalazine, and gold compounds, help slow the spread of the disease itself. In some cases, an injection of a steroid medication into the joint can help relieve swelling and inflammation.
 

Your doctor may also prescribe special shoes. If your toes have begun to stiffen or curl, you should wear a shoe with an extra-deep toe box. You may also need to use a soft arch support with a rigid heel. In more severe cases, you may need to use a molded ankle-foot orthotic device, canes, or crutches.

Exercise is very important in the treatment of RA. Your doctor or physical therapist may recommend stretching as well as functional and range of motion exercises. 

Surgical Options

Surgery can correct several of the conditions, such as bunions and hammer toes, associated with RA of the foot and ankle. In many cases, however, the most successful surgical option is fusion (arthrodesis). Fusion is often performed on the great toe, in the midfoot, in the heel, and in the ankle.

In this procedure, the joint cartilage is removed; in some cases, some of the adjacent bone is also removed. The bones are held in place with screws, plates and screws, or a rod through the bone. The surgeon may then implant a bone graft from the hip or leg. Eventually, the bones unite to create one solid bone.

There is loss of motion, but the foot and ankle remain functional and generally pain-free. Replacing the ankle joint with an artificial joint (arthroplasty) may be possible. However, this is a relatively new surgical technique. Whether it will be as successful in the long term as hip or knee replacement surgery is not yet known.
 

As in all surgeries, there is some risk. Infections, failure to heal, and loosening of the devices are the most common problems. Intravenous antibiotics and/or repeat surgery may be needed. Severe complications may require amputation, but this is rare. 

Recovery and Rehabilitation

Your doctor will prescribe pain medication for your use after the surgery. Before you leave the hospital, you will be taught how to use crutches. It takes a long time to recover from foot surgery. Here are some things to consider as part of your recovery:

• Ask friends or family for help in preparing meals and doing other activities of daily living.
• For the first week or so after surgery, keep your foot elevated above the level of your heart as much as possible.
• Be sure to do the prescribed physical therapy exercises. They will help you regain strength, motion, and the ability to walk.
• You won't be able to put all your weight on your foot for several weeks, and you may need to wear a special shoe or a cast for several months.
•  You will probably be able to resume ordinary daily activities 3 to 4 months after surgery.

RA is a progressive disease that currently has no cure. However, medications, exercises, and surgery can help lessen the effects of the disease and may slow its progress.

Why do I have a bump in the top of my foot?

Why do I have a bump on top of my foot?

A:

A bump on top of your foot can be caused by a few conditions. While many people think that it is caused by a neuroma, that is usually not the case. If it is soft, it can be due to a bursitis or ganglion cyst, both of which are soft tissue inflammations caused by pressure or trauma. If the bump on your foot is hard, it is often due to a bone spur. 

Bone spurs can appear on top of your foot in a number of places and is caused by arthritic changes in and around the joint. Arthritis is not unusual in the feet because of the pressure placed on them with each and every step. The arthritis causes bone spurs to form around the joint. The mechanics of some foot types predisposes you to have excess pressure around some joints. Other times, it's trauma that causes the bone spur formation.

Bone spurs can be treated in a variety of ways. Sometimes your pain is not due to the spur itself, but rather the inflammation of the soft tissue surrounding it. In these cases, anti-inflammatory medication or cortisone injections can manage the inflammation and eliminate the pain. When the motion of the joint is causing the spur to be painful, the use of a custom orthotic can be helpful in redirecting the excess stress on the joint. Of course there are times where the spur may need to be removed. In those cases, foot surgery would be required to remove the spur.

Visiting your foot doctor in Newark will provide you answers as to why your bone spur has formed and what can be done for it. Contact Dr. Raymond DiPretoro for an immediate appointment to learn all of your options.