Bilateral Heel Pain - Track

Abstract

HISTORY: JD a 10-year-old male presents with bilateral heel pain for the past 6 – 8 months. The onset of pain coincides with a time when he became more active in Track events in school. The pain is aggravated by running and improves with rest. Rarely does he feel the pain when walking. He points to both his heels posteriorly when asked for the location. He is unable to describe the nature of the pain. Initially, when the pain started, he said it would resolve after about 5 minutes of rest. Now, it usually takes about 1–2 hours of rest to go away completely. He also complains that the amount of running needed to elicit the pain is less now than a few months ago. His mom, who brought him in to the office says that when he first started complaining of pain, she thought they were growing pains but lately, he has been coming in from playing outside crying due to the severity of pain. He denies any swelling, redness or fever. No loss of weight in recent months. PHYSICAL EXAMINATION: He walks with no pain or difficulty. On examination of his extremities, he has full range of motion of his hips, knee and ankle with no pain. There is no swelling or erythema around the ankle or heels. He has some tenderness when pressure is placed on both his Achilles tendons. He also has marked tenderness when both sides (medial and lateral aspect) of his heels are squeezed (over the calcaneus). No tightening of the heel cord is appreciated. DIFFERENTIAL DIAGNOSES: Calcaneal Bursitis. Insertional Achilles' Tendonitis. Fat pad syndrome. Sever's disease (Calcaneal Apophysitis). Plantar fascitis. Calcaneal stress fracture. Tarsal Tunnel syndrome. Tarsal Coalition. Calcaneal Osteomyelitis. Bone Cyst in the Calcaneus bone. Bone Tumor in the calcaneus. TESTS AND RESULTS: None. FINAL/WORKING DIAGNOSES: Sever's Disease (Calcaneal Apophysitis). TREATMENT AND OUTCOMES: Rest or modification of his activities according to pain. Apply ice Locally. Ibuprofen. Instructions on home exercises were given (Gastrocsoleus stretching exercises and strengthening exercises for the foot dorsiflexors as well as the gastrosoleus and quadriceps). The patient and his mom were counseled that this is a benign condition with no long-term sequelae.