Knee and heel pain in children?
Young children often report pain 3-5cm below their kneecap or in the back of the heel when involved in physical activity. Parents often worry that they have a significant knee or ankle problem. But in most cases these children are complaining of Osgood-Schlatter’s or Sever’s. These are both conditions affecting pre-adolescents and adolescents, particularly those who are very physically active. Both these conditions tend to affect children between ages 11-15 years in boys and ages 8-13 years in girls. However, both of these conditions are more common in boys. Osgood-Schlatter’s accounts for around 13% of adolescent knee pain. Sever’s accounts for around 16% of all musculoskeletal injuries in children.

Why does this occur?
There are two types of growth plates in bones:
• One type of growth plate increase the length and thickness of the bone
• The other type of growth plate is found where large muscle tendons attach to a bone.
• Osgood-Schlatter’s occurs where the large quadricep muscles attach to the front of the lower leg. While Sever’s occurs where the large calf muscle (Achille’s tendon) attaches into the heel bone.
• During a growth spurt there is lots of bone activity and pain occurs with activity. Repetitive contraction of these large muscles causes traction on the growth plate and this can cause pain.

What are the symptoms?
• Constant dull ache
• Sore to touch in these areas
• Swelling in these areas
• Sharp pain during activities such as running, jumping and kicking
• In 60% of cases, the condition effects both sides
• Unable to complete normal training sessions
• A limp when walking
• Parents will often recognise a growth spurt

How to treat it?
Both of these conditions usually resolve by themselves with time, ~4-8 weeks. Treatment is usually based around activity modification. For example, reducing amount of overs bowled in the nets or not practicing running between wickets. Other treatment options can include taping, ice, pain-relieving medications, stretching, strengthening of the quadriceps or calf muscles and physiotherapy. In some cases, these symptoms can mimic other conditions. If the symptoms have not resolved within 4-8 weeks then it is best to seek the help of a Doctor or Sports Physiotherapist.

So the take home message is that nearly always the problem is nothing more than the conditions described above. There will be full recovery at the completion of the growth spurts. There is rarely a need to stop your activity completely but rather modify your training workload. Next time you are at an U13 junior sporting event, have a look at the youngsters who are limping or running flatfooted. They are experiencing the pain of Osgood-Schlatter’s or Sever’s.

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