Heel pain is a common problem in any "cleated" athlete, and something often treated at my physical therapy office. This essay will focus on the most common cause of heel pain in young soccer players.
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Differential diagnoses includes Achilles tendinitis, stress fracture, recurring ankle sprain, nerve entrapment, and plantar fasciitis. Just...don't assume that your Google degree has enabled you to reliably determine Severs disease from a stress fracture or achilles tendinitis.
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The problem is most often a condition known as apophysitis of the calcaneus (heel bone) or Sever's Disease. This label describes a repetitive overuse injury, with inflammation of the growth area of the calcaneus which has not completely closed together. It is most commonly seen in boys and girls between the ages of 10-15 who frequently participate in sports that involve running and jumping. The pain is usually present in the back and bottom surface of the heal.
Causes of Sever's Disease Include:
1. Training Errors
The issue often occurs abruptly when the athlete resumes running, cutting, and jumping activities too frequently or intensely after a period of relative inactivity. Other times, the condition develops gradually as the athlete continues to pound their joints with insufficient time for recovery between games and practices.
2. Footwear
Soccer cleats are intentionally created to minimize interference of the function of the foot. This is great for quick cuts and precision touches to a soccer ball, but leaves very little between the foot and the ground. Cleats that are too small are often a culprit, as are shoes with less than four cleats in the heel area.
3. Foot Structure and Function
Biomechanical imbalances such as high or low arches, or very stiff or loose joints, can be the root cause of the abnormal strain across the Achilles tendon insertion point on the heel bone.
Treatment: Beyond rest and heel cups
The most effective treatment usually includes measures to address some combination of the above problems.
1. Systematically apply stress to the body.
Plan ahead to gradually apply more stress the foot and ankle before jumping into a lot of repetitive agility and sprint work. At least initially, apply a limited number of high impact activities to build resiliency in the foot and ankle.
Wear cleats around the house for "everyday life" and light skill work before using them for more intense activities.
2. Address biomechanical issues.
The details of foot structure and function are beyond the scope of this essay. This is highly individual, and demands a thorough orthopedic evaluation of the entire athlete (not just the foot). Not all "low arch" feet need orthotics. They may respond well to a few exercises and shoe modification. But some athletes certainly do require an appropriate off-the-shelf or custom orthotic device.
3. Modalities
Applying ice and massaging the calf muscles and the area around (but not directly to) the tender area often helps. I've found Ultrasound treatment to be worthwhile to decrease pain and inflammation. While these do indeed help manage the symptoms, they don't address the root cause.
4. Taping Techniques
There are a few flexible (aka kinesiotape) and traditional taping techniques that effectively reduce the overload of the heel bone. Sometime this is enough to get the athlete outside of the threshold of injury. Which technique and type of tape may work best depends on the static and dynamic (movement) patterns the athlete displays.
5. The quick fix. ***
I've hit upon a quick fix (of sorts), and will usually try this in combination with a few targeted exercises and temporary activity modification prior to considering an orthotic or other more intensive intervention.
The quick fix is a 1/4" semi soft heel lift that runs from the heel and gradually tapers to the ball of the foot. This works far better than Dr. Scholls type insole because they don't take up room in the toe box area where the athlete is accustomed to a form fitting shoe. And unlike gel "cushion" heel cups, they don't slide around in the shoe. They also provide more lift than squishy gel. A quarter inch is usually enough to lift the posterior half of the foot just enough to allow for mitigating the Achilles tendon pull on the calcaneus.
I make these in the orthotic lab and they often do wonders for athletes stuck in a rut of heel pain.
Try these tips and let me know if you have any questions.
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