Foot Pain In A 10-Year-Old: Growing Pains Or Something Else?
Elaine is a bubbly 10-year-old girl who came to our clinic with her mum, Sandy, after being diagnosed with growing pains in the heels by her GP. Elaine is very sporty, and her dance classes are one of her favourite things to do.
Elaine’s pain was mainly at the back and bottom of both heels, but she did say that it went into the inside of her ankle at times too. The pain was worse when she was up on her feet and felt better during rest.
Elaine’s Foot & Leg Check
After chatting with Elaine and Sandy about her history and previous injuries, our podiatrist completed Elaine’s exam. We noted significant pain when pressing at the bottom of her heel, at her posterior tibial tendon, at the inside of her ankle, and when squeezing both her heel bone and her Achilles tendon.
We noted that Elaine’s joints were very flexible, scoring 7/9 on the Beighton’s hypermobility score. Elaine’s joint and muscle strength were both normal, but she had extremely flat feet, with her arches essentially touching the ground. Her sports shoes were doing very little to support her foot posture, with no beneficial arch support and no firm shank through the shoe to provide more stiffness, stability and control.
Diagnosis: Not Just Growing Pains!
Based on our assessment findings and analysis of Elaine’s gait, we diagnosed her with:
- Plantar fasciitis - causing heel pain at the bottom of her feet. This is the damage to and inflammation of the plantar fascia tissue that starts at the bottom of the heel and fans to attach to all five toes
- Achilles tendonitis - causing pain at the back of her heels. This is damage and irritation of the Achilles tendon, which is aggravated by movement
- Bursitis (retrocalcaneal) - contributing to the pain at the back of her heels. A bursa is a cushion-like fluid-filled sac that sits between a tendon or muscle and bone to help them move smoothly past one another, instead of rubbing against one another and causing damage. For Elaine, it’s likely that her Achilles pain and her bursitis are related, with this particular bursa sitting between the bones at the back of the heel and the Achilles tendon
- Calcaneal apophysitis - this technical name for growing pains at the back of the heels. Growing pains occur when the growth plates are irritated or damaged. Growth plates are present in all growing children and are where the body adds new bone tissue so our bones get bigger and longer. Growth plates are weaker than the surrounding bone, so when stress is applied to the surrounding bone (like from the Achilles tendon), the growth plates can become irritated, inflamed and painful
- Tibialis posterior tendonitis - causing the pain on the inside of her ankles. The posterior tibial tendon is an important tendon that travels down the inside of the leg and ankle, connecting to the bottom of the foot and supporting the arch. Without this tendon, we’d struggle to stand on our tip-toes
It was Elaine’s high levels of physical activity paired with her hypermobility that was placing excess stress on her muscles, tendons and ligaments.
Elaine’s care consisted of:
- Teaching her and her mum the right taping techniques for her dance classes - which were also videotaped on her mum’s phone for accuracy
- New footwear that had the right supportive characteristics for her feet
- Orthotics that would keep her feet supported and ease the tension on her damaged tendons
- Icing, ball-rolling and frozen water bottle massage techniques
The goal for Elaine’s treatment was to allow her to continue to perform her dance classes and sports with minimal to no pain.
We first reviewed Elaine 3 weeks after implementing her treatment plan. The initial results were very promising, with a 50% improvement in symptoms reported by Elaine. Mum Sandy also mentioned that Elaine was not complaining of pain anywhere near as much.
Elaine had been wearing her new Asics shoes, doing her exercises and was taping regularly for dance. Orthotics were fitted at this appointment to accelerate her healing process. We also taught Elaine how to properly foam-roll her calves, and how to Rocktape her Achilles tendon for maximum support.
A month later, Elaine’s mum reported that her pain levels had continued to improve, and she was no longer waking at night in pain. Elaine did have some mild blistering within the first few days of her new orthotics, but this is much better now and she is wearing them comfortably without any problems.
A few months later, there was no longer any pain when assessing and feeling the damaged structures. Elaine mentioned that the pain can return to a mild extent if she dances or plays with friends without having her feet taped. We encouraged both Elaine and Sandy to continue with all the physical therapies and to remember taping when performing weight-bearing activities without the support from the orthotics and good footwear.
Elaine’s next check has been scheduled for a months’ time and we expect to see complete resolution of her problems - without her ever needing to stop her dance classes.