My Child Is Complaining of Heel Pain

What Is Causing It and How Can I Help Them?

By Dr. John Goodner

Dr. Goodner is a Board Qualified
Reconstructive Foot & Ankle Surgeon
specializing in sports medicine foot and
ankle injuries, arthroscopy, trauma &
deformities in patients of all ages.

Painful inflammation to the growth plate (calcaneal apophysis) in the back of the heel is know as Sever's Disease. This ailment is most common in young soccer, baseball and basketball players due to the cleat patterns on shoes for these sports along with the specific demands these sports place on the heel region.

Why is my child having heel pain?

This type of heel pain typically occurs after overactivity in children between the ages of eight and fourteen. Tight muscles in their lower extremities, especially the calves and hamstrings, are usually to blame for the pain's onset. 

Many children who experience heel pain like this have associated flatfeet as well. Growth spurts can aggravate the condition further due to your child's body trying to adjust to the increased tension from already tight muscles on the calcaneal apophysis. Poor shoes or walking barefoot on hard surfaces can aggravate the heel's growth plates as well.

How do I know if my child has Calcaneal Apophysitis (Sever's Disease)?

• Your child will display discomfort in the heel bone at the end of an activity. 
• You will typically see stiffness in their foot in the morning and pain while walking. 
• Their pain will be alleviated by rest and a decrease in activity.
• Stiffness and pain will usually present after a child is done with activity, sits for a period of time and then tries to get up and walk.
• Tenderness to the back, sides and bottom of the heel from touch or grasping of the heel.
• You may notice your child walking on the ball of their foot to avoid touching their heel to the ground.
• Discoloration and swelling likely won't be seen.
• Limping at the end of activity that persists as the condition worsens is another sign.

How can my child's pain get better?

There is always a need to modify or avoid activities that aggravate the injury and avoid going barefooted. Taping the foot to decrease pulling on the plantar fascia is a good relief option. Proper shoes along with heel lifts can decrease pressure and tension on the heel.

Night splinting to stretch tight calf muscles and arch ligaments can maintain flexibility gained from calf stretching. Custom molded orthotics are necessary to support the foot and help to restore proper alignment in cases where flat feet contribute to the heel pain.

Physical therapy to improve flexibility and diminish inflammation of the growth plate may be necessary if symptoms persist after these home care options and activity modification do not work. Occasionally, immobilization in a cast or brace to completely rest the heel and allow healing may be necessary. 

Prognosis is excellent in most cases when a treatment plan is followed.

Use our online scheduler to book your appointment! If you have a busy schedule during the week, we are open Saturdays by appointment only in our recently redone Plantation office.

Click here to book your appointment and get your child back to their best!

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👣 Foot and ankle injury prevention and treatment should be easy ... with South Florida Institute of Sports Medicine, it is!

✅ South Florida trusts us to get them back to their best.

Make your appointment online at www.SouthFloridaSportsMedicine.com

Ankle Arthroscopy Might Be the Solution You Need

Why does my ankle hurt??

What might have caused it?

Foot and ankle injuries are very common in sports but are also caused by regular activities in your daily life. There are many structures, including bones, ligaments, cartilage and joint lining around the ankle that may be damaged as a result of an injury.

Injuries can happen from a single traumatic event, from overuse, or from a previously untreated injury that manifests itself later in life. Joints like the ankle are designed to give our bodies freedom of movement, and any injury to them may alter your lifestyle.

Ankle Injury Symptoms

• Injuries may cause stiffness and pain in the foot or ankle joint, especially when you first get out of bed in the morning and start to walk around. The stiffness/pain will be present for a period of time proportional to the degree of injury in the joint.
• With weight-bearing, the joint usually loosens and the person is usually able to walk about or even run. Stiffness and pain will redevelop if the person sits for a period of time then tries to get back up and walk again.
• As the day continues the foot or ankle may begin to ache, especially with excessive weight bearing.
• Swelling may be present over the injured area.
• Instability may develop if the ligaments have been injured, causing the foot or ankle to constantly twist.

Ankle Injury Treatment

• When these injuries are unresponsive to conservative treatment (including orthotics, oral medication or injections, or rehabilitation) arthroscopic surgery may be necessary to remove the damaged tissue in the foot and ankle.

Ankle Arthroscopy Procedure

A miniature camera (between 1/8 and 1/6 inch) is placed into the injured joint and begins transmission to a television screen.The joint is visualized and small instruments, including a laser, are introduced into the affected area to clean out and repair the damage. 

Often, surgery includes removal of bone and/or cartilage fragments. Following that, we suction debris and smooth rough surfaces, often allowing for a joint to resume its normal gliding motion.

If cartilage is torn, loose or lifted, it is removed and small holes (microfractures) are placed in the bone to allow a regrowth of the cartilage. Although not the original cartilage (hyaline) the resurfacing with fibrocartilage is beneficial. Biocartilage implantation may also be performed to transplant cadaver cartilage and provide scaffolding for cartilage regrowth.

Conditions Treated by Ankle Arthroscopy

• Chronic joint pain and swelling
• Arthritis and bone spurs
• Loose bone and cartilage fragments
• Stiff, scarred joints
• Chronic instability
• Ankle fractures that never fully healed and cause persistent stiffness
• Dancers Posterior Ankle Impingement "OS Trigonum" Syndrome
• Chronic Synovitis

Advantages of Ankle Arthroscopy

• Minimally invasive, with a faster recovery time
• Less pain and swelling
• Avoidance of large incisions and scars
• Lower risk of infection
• Outpatient procedure
• Quicker return to regular activities and sports

When conservative treatments fail to alleviate pain and deformity of a joint, arthroscopic surgery should be considered. The surgical procedure is especially helpful for a fracture in the ankle join even after the ankle joint has been fixed surgically. Cartilage in the ankle joint may have been damaged during injury and cause chronic stiffness and pain that may be mild but never completely goes away.

Patients often think this is a condition they can live with, however, once treated arthroscopically a full return to activity may be possible. It's always the best treatment option for athletes and dancers.

Use our online scheduler to book your appointment! If you have a busy schedule during the week, we are open Saturdays by appointment only in our recently redone Plantation office.

Click here to book your appointment and get yourself back to your best!

Numbness & Tingling In My Toes...

...What can I do for my Neuromas?

To understand what neuromas are, what causes them, treatment options and long-term prognosis, you need to start with a quick definition of a nerve. 

According to Merriam-Webster, a nerve is "any of the filamentous bands of nervous tissue that connect parts of the nervous system with the other organs, conduct nerve impulses, and are made up of axons and dendrites together with protective and supportive structures."

The nerves we are referencing for neuromas are small, string-like structures that provide sensation and/or give the signal to muscles to move.

So, What Are Neuromas?

Some nerves in the foot & ankle may be susceptible to injury because of their location. The most commonly injured nerves here are on the ball of the foot, located at the base of the second, third and fourth toes. These nerves provide sensation only to the middle three toes and may be compressed by a ligament that runs over it. A neuroma is when something, like inflamed tissue or other object in the body, presses on the nerve, causing irritation.

Signs & Symptoms of Neuromas

• Pain on the ball of the foot.
• Numbness, or a burning/shooting/tingling sensation in the toes. Either or both of these may be present.
• Cramping in the toes
• Aggravation by activities like running, aerobics or activities that put stress on the ball of the foot.
• Lessening of pain when removing the shoe and rubbing the affected area.
• Aggravation of pain in the ball of the foot from driving, by high heels or by walking barefoot.
• Numbness in the foot while active; for example, while on a treadmill or elliptical, doing lunges or Zumba-style classes.

Causes of Neuromas

Difference between an unaffected nerve
and a Neuroma, from
SouthFloridaSportsMedicine.com/neuroma.html

• Compression of the nerve against a tight ligament that connects the metatarsals.
• Arthritis or bone spurs in the adjacent joints.
• Soft tissue cysts causing nerve compression.
• Trauma to the ball of the foot.
• Nerve irritation from tight shoes; excessive barefoot walking on hard floors; tennis, running and other exercise that put stress on the ball of the foot.

Treatment for Neuromas

Treatment for neuromas, as with all cases we see, begins with a thorough history and physical examination of the foot with an emphasis on the affected areas. The goal of treatment will be to reduce inflammation around the nerve and prevent further trauma from occurring. Treatment may include, but not be limited to:

• Use of anti-inflammatories to lessen inflammation. Oral medication or cortisone injections can be beneficial in many cases.
• Changing to wider, cushioned shoes without high heels.
• Temporarily changing physical activity to non weight-bearing exercises like biking and/or swimming.
• Physical therapy to reduce inflammation in the affected areas.
• Use of metatarsal pads.
• Fitting of orthotics to correct faulty biomechanics. These devices can be used in smaller heels and all athletic shoes.
• Localized injections into the nerve to temporarily stop transmission of impulses from the affected nerve(s), also known as sclerosing alcohol injections.
• Surgical removal of the nerve may be necessary if conservative treatment fails.

The cases where surgical treatment becomes necessary are few and far between, as most neuromas respond to conservative treatment. In those cases where surgery is required to alleviate pain associated with a neuroma, patients can expect a short outpatient procedure with one-two days of accompanying rest. The procedure is done under local or twilight anesthetic and the patient will need to wear a surgical shoe for the following 4-5 days. Post-operative pain is minimal, but physical therapy may be necessary for a short period. 

Within 2-4 weeks, the patient can progress back to wearing regular shoes. Certain physical activities like swimming or biking can resume within 1-2 weeks, but other sports may require avoidance for up to 8 weeks.

Prognosis (Short & Long-Term)

One word: EXCELLENT!

Use our online scheduler to book your appointment! If you have a busy schedule during the week, we are open Saturdays by appointment only in our recently redone Plantation office. 

Click here to book your appointment and get yourself back to your best!

Learn more about neuroma treatment and view surgical photos here.

Orthotics FAQs

The key to better health could be right under your feet. Watch this video that highlights what orthotics can do for you.





Check out the orthotics page on our website for more information! 

👣 Foot and ankle injury prevention and treatment should be easy ... with South Florida Institute of Sports Medicine, it is!


✅ South Florida trusts us to get them back to their best.



Make your appointment online at www.SouthFloridaSportsMedicine.com

Treating Your Foot & Ankle Pain with Shockwave Therapy

Non-Invasive, FDA Approved, Highly Effective Treatment for Your Acute Foot & Ankle Pain

Extracorporeal Pulse Activation Technology®, or EPAT®, is a type of Shockwave therapy that delivers pulses of sound waves that cause microtrauma, or microscopic injury to the soft tissue and/or bone the therapy is being used to treat. This trauma stimulates inflammation which is critical to healing along with blood flow to the injured area. Damaged tissue then begins to regenerate and, eventually, heal.

EPAT is a non-invasive treatment that can
alleviate pain from many lower extremity
ailments.

What is EPAT® useful for?

• Plantar Fasciitis
• Achilles Tendonitis
• Shin Splints
• Heel Spurs
• Painful Trigger Points
• Joint Inflammatory Conditions
• Tendonitis (Tendon Injury/Inflammation)

What are the expected results?

The beneficial effects of Extracorporeal Pulse Activation Treatment (EPAT®) are often experienced after as few as 3 treatments. Some patients report immediate pain relief after the treatment, although it can take up to four weeks for pain relief to begin. The procedure may eliminate pain and restore full mobility, thus improving your quality of life. Over 80% of patients treated report to be pain free and/or have significant pain reduction. 

It is important to understand that not all injuries will respond to EPAT®. Some injuries are too advanced and other treatment methods may be necessary (including injections and surgery) for pain relief.

Is it safe?

Yes. This FDA-cleared technology was developed in Europe and is currently used around the globe. A wealth of medical experience, state-of-the-art engineering and optimal quality have been built into each EPAT® device, and extensive clinical studies and tests have confirmed its safety and efficacy. 

If performed by a qualified caregiver EPAT® has virtually no risks or side effects.

What is the duration of the treatment and how many treatments will I need?

Treatment sessions take approximately 5-10 minutes, depending on the disorder to be treated. Generally, 3 treatment sessions are necessary at weekly intervals.

What will happen after the treatment/procedure?

You will receive post-treatment instructions from your physician to follow during your recovery.

What if I have a special health condition?

The safety and effectiveness of the EPAT® procedure has not been determined on people with the following health conditions. Your doctor will provide you with information about how these and other conditions might affect the determination to perform the EPAT® procedures.

• Malignancies
• Deep Vein Thrombosis (DVT)

How is the treatment performed?

Coupling gel is applied to the treatment area of interest to enhance effectiveness. After these preparations, EPAT® pressure waves are released via the applicator moved over the area of interest in a circular motion.

Why Consider Non-Invasive EPAT®?

EPAT® has a proven success rate that is equal to or greater than that of traditional treatment methods (including

surgery) and without the risks, complications and lengthy recovery time. EPAT® is performed in our physician's

office/clinic, does not require anesthesia, requires a minimal amount of time, patients can bear weight (i.e. walk) immediately, and return to normal activity within a few days of the procedure.

Benefits of Non-Invasive EPAT®

• You can, usually, immediately bear your full weight on your feet rather than need recovery time post-surgery or otherwise.
• You can be treated on both lower extremities at the same time.
• No incision or related risk of infection at the treatment site.
• No chance of scar tissue.
• Return to normal activities within 24-48 hours and strenuous activities after as few as 4 weeks.
• Evaluation of treatment success as soon as 12 weeks.
• Over 80% successful outcome for longterm pain relief (data published and results retained in further study)
• Non-invasive treatment means biomechanics are not affected, allowing for other future treatment options.
• Cost effective, reduced cost from lack of lost work.
• Fast, safe & effective, without need for anesthesia.

What are the possible side effects/complications?

The non-invasive EPAT® treatment has virtually no risks or side effects. In some cases patients may experience some minor discomfort which may continue for a few days. It is normal to have some residual pain after intense exercise or a full-day of work.

Will my insurance cover EPAT® treatment?

In almost all cases, insurances will not cover EPAT®. The cost for 3-4 sessions is $500

Use our online scheduler to book your appointment. If you have a busy schedule during the week, we are open Saturdays by appointment only in our recently redone Plantation office. 

Click here to book your appointment and get yourself back to your best!

Bunion Surgery

Do you have a painful Bunion? Here's what surgery to repair it looks like:

Check out our pre- and post-operative Bunion clinical photos on our website.

👣 Foot and ankle injury prevention and treatment should be easy ... with South Florida Institute of Sports Medicine, it is!

✅ South Florida trusts us to get them back to their best.

Make your appointment online at www.SouthFloridaSportsMedicine.com