Heel, foot and ankle pain

Heel pain is common in children, especially during puberty when there is an accelerated rate of bone growth and significant changes in hormone levels

• Severs Disease is a common cause of heel pain in growing children; the Achilles tendon pulls on the active growth plate at the back of the heel.
• The vast majority of growth related pain is not serious and will resolve quickly with muscle stretches.
• Some children may also benefit from strengthening exercises.

Action: Key assessment points

• Observe gait
• Check for full range of movement of hips, knees, ankles and feet, including subtalar joint is full and symmetrical
• Heel squeeze test and palpate around heel growth plate to ascertain area of pain
• Check lower limb muscle flexibility, especially calf muscle length
• Painful, stiff or rigid flat feet may indicate tarsal coalition

Action: Referral not indicated

• Mild pain with no muscle tightness
• Educate and reassure parents/guardians. The majority of heel pain will resolve with improved flexibility
• Give heel pain in children leaflet and advice, advise patient to try exercises prior to referring to physiotherapy

Action: Refer to Paediatric Physiotherapy

• Tight/weak muscles despite trying exercises in heel pain in children leaflet and/or poor core stability
• Persisting/chronic pain
• Difficulty in functional activities or reduced activity levels due to pain e.g. running, jumping, PE
• Reduced/non weight bearing

Action: Refer to Paediatric Orthopaedics

• Indication of serious orthopaedic pathology/red flags
• Limping child with no trauma/mechanism of injury
• Stiff/rigid painful feet
• Pain that has not resolved despite Physiotherapy