Why does the heel growth area hurt?
The apophysis of the calcaneus is a separate ossification nucleus that is attached to the main bone through a cartilaginous layer. The powerful Achilles tendon is attached to it above, and the plantar fascia below. When running and jumping, both structures simultaneously pull the apophysis in different directions, and the heel itself receives an impact on the hard surface. The cartilaginous growth zone is less strong than bone, so it is the one that reacts to overload. During the growth spurt, bones lengthen faster than muscles, the calf muscles become relatively short and tension increases - hence the seasonality of complaints during periods of active growth.
- Achilles tendon traction behind the growth plate
- Impact load when running and jumping
- Relative shortening of the calf muscles during a growth spurt
- Hard shoes without cushioning and hard surfaces
- Flat or, conversely, hollow foot with poor shock absorption
Symptoms
The pain is located in the back and sides of the heel, intensifies after running, jumping and long walking, and decreases with rest. A characteristic symptom is pain when squeezing the heel on both sides with the palms. The child begins to walk on his toes, limp at the end of training, and refuses to play. Externally, the heel is usually not changed: there is no pronounced swelling or redness, and this is an important difference from inflammatory and infectious processes. Complaints are often two-sided.
- Pain at the back and sides of the heel
- Increased pain after exercise, relief with rest
- Pain when lateral compression of the heel
- Walking on toes, gentle gait
- Limitation of dorsiflexion of the foot
- Both heels are often affected
Diagnostics
The diagnosis in most cases is clinical: age, typical location of pain and a positive heel compression test. X-rays are taken not to confirm, but to exclude other causes - stress fracture, bone cyst, tumor. Fragmentation and compaction of the apophysis in the image are also found in healthy children, so the diagnosis is not made on its own. Ultrasound helps evaluate the Achilles tendon and the bursa underneath it. MRI is rarely prescribed, in case of an atypical picture, night pain or lack of effect from treatment.
- Examination by an orthopedist and heel compression test
- X-ray of the heel bones to exclude other causes
- Ultrasound of the Achilles tendon and heel area
- MRI for night pain and persistent complaints
- Complete blood count and C-reactive protein if inflammation is suspected
What to do: treatment and exercise
The main thing is to reduce the shock load, but do not put the child to bed: complete rest weakens the muscles and delays recovery. During the period of pain, reduce running and jumping, replacing them with swimming and cycling. Soft shock-absorbing heel pads, shoes with a small heel and good sole, ice for 10-15 minutes after exercise, daily stretching of the calf muscles and strengthening the foot muscles help. Painkillers are used for a short course and only as prescribed by a doctor. Injections in the area of the growth plate are not given to children.
- Reducing the amount of running and jumping for several weeks
- Shock-absorbing heel pads or insoles
- Stretching the calf muscles and Achilles tendon daily
- Cold after exercise
- Swimming and cycling as an alternative
- Physiotherapy course prescribed by an orthopedist
Prognosis and prevention
Schinz's disease leaves no consequences: after the growth plate is closed, usually by the age of 14–16, the pain disappears forever; it does not cause deformation or arthrosis. Before this, exacerbations are possible when returning to intense training, especially on hard surfaces and in worn-out shoes. Prevention comes down to a gradual increase in load, regular stretching and timely change of sports shoes. If pain lasts longer than several months or behaves atypically, the diagnosis should be reconsidered.
- Complete recovery after closure of the growth plate
- Gradual increase in training loads
- Regular stretching of the legs and feet
- Shoes with shock-absorbing soles, timely replacement of sneakers
- Warm up before training and cool down after