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Heel Pain in children Care Pathway Overview

Heel pain in children can be a normal part of a child's development and is usually of a normal pathology and does not require referral into Orthopaedics. Please manage in Primary Care with advice, encouragement and self-management.

Practice Point

The advice in this pathway applies to patients up to musculoskeletal maturity at approximately 18 years of age

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Red Flags
  • Persistent pain, redness, heat, swelling, raised body temperature
  • Frequent nocturnal pain
  • History of trauma/injury/fracture
  • Inability to weight bear
  • Multiple joint pain/swelling
If fracture suspected, follow the Fracture pathway
If infection suspected, treat accordingly
For persistent foot or ankle pain, weakness, limping swelling or stiffness, encourage patient to self-refer into Core Podiatry / Physio Direct Services (GCS)
Presentation
  • Heel pain is common in young people between the ages of 10 and 14. It is usually a result of irritation to the growth plate at the back of the heel bone. These growth plates fuse around the age of 16.
  • Often aggravated by muscle tightness in the lower leg.
  • High levels of sporting activity may cause pain to vary.
Differential Diagnosis
  • Haglunds deformity
  • Achilles tendon injuries
  • Tarsal coalition
  • Inflammatory arthritis
  • Fracture (follow the Fracture pathway)
  • Infection (treat accordingly)
  • Neurological disorders causing tight Achilles tendon – e.g. cerebral palsy
  • Bone cysts/tumour
Initial Primary Care Assessment

Assessment

Pain is often felt underneath the heel bone. Squeezing both sides of the affected heel is often painful.

Primary Care Management

Heel pain in children is a normal part of a child's development and is usually of a normal pathology and does not require referral into Orthopaedics. Please manage in Primary Care with advice, encouragement and self-management.

Provide advice/encouragement:

Practice Point

The advice in this pathway applies to patients up to musculoskeletal maturity at approximately 18 years of age

When to Refer

If additional support is required to manage the problem, Gloucestershire Care Services (GCS) provide Podiatry and Physiotherapy services in Gloucestershire.

These services can be accessed via the below online self-referral forms which the patient can complete themselves if able to and willing.

Referral Criteria

Consider referral to Podiatry if:

  • Heel pain with associated foot pain or footwear problems
     

Consider referral to Physio if:

  • The patient has heel pain with associated knee/leg/hip/back pain
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