Does your child always complain of foot pain? Were you told it was growing pains but you don’t understand what that means? You are not alone! This is a question many people ask when they see me either in the office, at synagogue or on the ball field.
With so many of our children enrolled in multiple competitive sports, they are bound to suffer from growing pains in one form or another.
The medical word for this problem is osteochondrosis, which is a term used to describe a group of disorders that affect the growing skeleton. The growth plate is mad up of cartilage, which is softer and more vulnerable to injury than mature bone. The exact cause of these disorders is unknown, but it is often from overuse of the developing growth plate and surrounding bone maturation centers.
Overall, boys are more affected and symptoms generally appear between three and 14 years of age. It is thought that boys are more commonly affected because of their greater susceptibility to childhood trauma and overuse injuries. Patients usually present with pain and disability. Parents become concerned as the pain often prevents the child from wanting to play in his/her competitive sport. The pain can come and go, but it can also be so severe that the child has pain even when going from a sitting to standing position.
Although these growing pains can occur in the leg and arms, I would like to focus on three specific areas in the feet that our children are susceptible to these pains and irritations.
The first, and probably most common, is known as Sever’s disease. Do not be overly worried with the term “disease.” The problem affects the growth plate at the back of the heel bone. The Achilles tendon exerts tensile forces on the growth plate with physical activity. Most children associate their symptoms with a particular sport, with soccer being the most common. Symptoms are worse at the beginning of a new sports season. Weight-bearing activity and shoes, particularly cleats, as well as child obesity, can aggravate the symptoms.
A second “disease” is known as Köhler’s disease. This is an osteochondrosis of the navicular bone, a bone that sits on the inside of the foot near the arch. Children often present between four and eight years of age, and boys are more likely to be affected. Usually there is no history of previous trauma. Pain in the arch and a limp are the most common presenting symptoms. There is point tenderness over this bone on examination. It is a self-limited condition and symptoms will eventually resolve. If very tender, a short leg cast for several weeks can reduce the symptoms.
A similar condition can affect children a bit older but in the same area of the foot. This is called accessory navicular syndrome. Some people are born with an extra bone in the foot, and our tendon is attached to this bone. The tendon causes traction on this extra bone, which can get irritated with prolonged activity, or even with flat, low-profile, unsupportive shoes.
The last “disease” is known as Iselin. Iselin disease is painful irritation and inflammation of the growth plate of one of the bones along the outside of the foot where a tendon inserts. It is often seen in physically active boys and girls between the ages of eight and 13 who are involved in soccer, basketball, gymnastics and dance. One can diagnose Iselin disease based on a review of your child’s symptoms and physical examination of the foot.
Treatment for all three are similar. Rest, ice, anti-inflammatory medication and immobilization with a boot or a short leg cast can be used. Sometimes special heel cups, custom molded orthotics and/or physical therapy are needed. It is very important to stretch tight calf muscles to relieve tension on the growth center.
If your child is complaining of foot or ankle pain that is not resolving in a timely manner, it is important to see a foot specialist for proper diagnosis and treatment. We at the Center for Musculoskeletal Disorders would love the opportunity to help him/her get back to his/her sport pain-free.
By Daniel Popowitz, DPM, FACFAS
Dr. Popowitz is a board-certified foot and ankle specialist in private practice at the Center for MSK Disorders in Englewood, NJ, Queens and Brooklyn. He is board certified by the American Board of Foot and Ankle Surgery. To make an appointment, please call 201.510. 3777 for NJ and 718.759. 6100 for NY.
