Symptoms & Assessment
- 10 year-old schoolboy playing a minimal amount of sport at school
- Pain and moderately sized swelling/lump over the back of the right heel
- Had started to spread up into the calf and down into the sole of his foot.
- Aggravated by playing football, running and walking.
- His GP had X-rayed the foot to clear a bony tumour, and then referred him to the clinic, with Sever’s Disease as the suspected condition (common condition causing heel pain during growth spurts in children)
- On assessment walking with a limp and turning his foot out to the side to avoid putting a full stretch on his calf
- Also stiff big toe (possibly from kicking a heavy piece of furniture a couple of months before), a tight sole of the foot and tight calf on that side.
- Lower ankle joint also stiff and absorbing less impact as a result. His football boots were found to be slightly tight due to a recent growth spurt.
Self management strategies with some in-clinic treatments.
- Home: Ice, Anti inflammatory gel, no tight footwear for school (and none at all at home), new football boots, home stretches for the calf and foot
- Clinic: Soft tissue release to sole of foot, tight toe tendons and calf
- Joint mobilisations for heel and big toe joint
- Progressive calf loading exercises.
After the first week, his symptoms had reduced by 50% and he was re-treated as before.
Then another week of self-management, during which he restarted playing football. Reviewed at the 2 week period with no symptoms and a much smaller heel lump. Some stiffness remained in the calf and the forefoot, so these were re-treated and he was then sent away with an ongoing plan and to call a week later with an update.
A week later, there were no pains on playing football, running and other strenuous activities and the lump was almost non-existent. He was then discharged with an ongoing set of stretches to do, bearing in mind his current growth patterns.
He remained pain-free at the 6 week stage.