Heel Pain in Kids

Kids have an incredible ability to deal with pain.  I’ve seen young children take bad falls, run into walls, or accidently get hit by a flying object and not miss a beat.  They are stunned for a second, might shed a quick tear, but before you know it, they are back running around having fun.  Despite their ability to play through discomfort, there is a specific type of heel pain that seems to bring kids to the doctor that we should discuss.

In order for a child’s bones to grow, the body forms a “growth plate” which allows bones to grow in length.  These growth plates stay open into a child’s teenage years, allowing for maturation of their bodies.  These growth plates are very sensitive to injury and are easily irritated.  In a child’s heel, there is a growth plate which is commonly irritated as a child becomes more active in sports.  The Achilles tendon is attached to this growth plate, which leaves the growth plate susceptible to the strong pull of this strong tendon as the bone grows.   This is a very common condition in kids, which is called Calcaneal Apophysitis, or Sever’s Disease.

Symptoms that most children will experience are heel pain toward the end or after playing sports.  There may be some mild swelling, but no bruising and the child will not be able to recall a specific event that caused their heels to hurt.  Pain will slowly go away with rest, but will return if participation in sports is re-started.  Sever’s disease is very commonly seen at the beginning of a new sports season, when wearing tight cleats or new athletic shoes,  or when suddenly increasing activity after a relatively less active time period.  Most children will recognize that something is not right and complain of their feet hurting.

Thankfully, this condition is very common and is not associated with long term foot pain.  With some slight modification to shoe gear and other minor changes, most children will be pain free in 2-4 weeks and not miss any part of their athletic season.  We’ll discuss treatment options next post.

Surgical Treatment of Warts

If conservative treatment for warts is unable to effectively kill the virus, or the warts seem to recur frequently to the point that weekly visits to the podiatrist for the next couple months are needed, it is reasonable to pursue surgical removal.  Although the warts can come back, this is an effective method of treatment. This can be accomplished in different ways.

The simplest way to achieve wart removal is simply to cut it out.  If there are only a couple warts and if they are not too deep, this can be done with local anesthetic in the office.  A small amount of numbing medicine will be put around the wart to make the procedure as painless as possible.  The procedure is done with a scalpel and a curette, which allows the podiatrist to completely remove all virus infected tissue.  A small dressing and some ointment will then be applied and need to be changed for the next couple weeks while the wound heals.  The location will be tender for the upcoming weeks, so wearing a special shoe that off loads the area may be more comfortable.

If the wart is too deep or the involvement is too wide spread, it may be necessary to be taken to the operating room for removal there.  The procedure is the same as outlined above; however, the patient is sedated in addition to the local anesthetic to decrease the amount of pain.  This allows the doctor to be more aggressive to insure complete removal of warty tissue.  Cautery and/or lasers are now often used to burn the edges of the previous wart to kill any additional virus left behind.  This process of curettage, followed by cautery, then repeating the cycle can be very effective in killing the virus.

Although warts are certainly not life threatening, if they are found on the weight bearing surface of the feet, they can alter your activities and decrease your ability to experience painless exercise.  Talk to your podiatrist if you are struggling with recurrent planter’s warts.  Together, you will find a solution to the problem.

Warts Treatment Continued

Wart treatment continues to develop and newer treatment modalities continue to come out.  Let’s discuss some of the more popular treatments.

The reason why warts persist so long is that they hide from the immune system by living in the thick skin of the plantar skin.  A popular theory now being investigated is injecting something into the wart that will alert the immune system.  Candida albicans, a yeast known for causing oral thrush and yeast infections, has been injected into warts.  The immune system then begins to attack the yeast, and at the same time realizes the presence of the wart and begins to attack it.  This treatment has shown promising results in some, but doesn’t work for everyone.  Talk to your podiatrist if you are interested in attempting this mode of treatment.

Another treatment for warts is called bleomycin.  This may alarm some of you who know that this medication is a chemotherapy agent for those undergoing cancer treatments.  However, when using this medication for wart treatment, bleomycin is diluted down and is only injected into the most superficial part of the skin, similar to how TB tests are done.  Bleomycin stays locally inside the wart and does not get into your circulation.  After one application, the wart will turn black over a 2 week period.  The wart is then debrided using a scalpel.  Often, only one or two treatment is necessary.  If used correctly, this treatment is very effective in only a few office visits.

Another product being used for wart treatment is canthacur.  This is a product that comes from the saliva of an exotic beetle.  It is a very potent chemical that when applied to skin will cause blistering and lifting of the skin, which will cause the wart virus to die.  This is a newer treatment that is slowly gaining favor.  The most commonly seen problem with this treatment is that the chemical, when the foot begins to sweat, will dissolve and not stay over the affected area.  This will obviously decrease the effectiveness of the treatment.

If these conservative measures fail, there are some surgical options that can be pursued.  We’ll discuss these next post.

Warts Treatment

Warts have become so common that health professionals use a myriad of treatments, not to mention home remedies and folk remedies that are shared on personal blogs and websites alike.  We’ll go over some of the more common treatments used by professionals, and mention some of the more popular home recipes.

The best treatment for any condition is prevention.  The best way to prevent picking up the virus is to wear footwear in public areas where water is present.  Be especially careful around locker room showers at health clubs, or at public swimming pools.  If you have an open cut or a break in the skin, be especially cautious.  If you think your shower may be contaminated, a dilute bleach cleaning solution will be sufficient to remove the virus.

A common treatment used by podiatrists is salicylic acid.  This acid works by slowly eating away at the skin infected by wart.  The acid is in a cream form, is applied every week for 5-6 weeks, and is covered with a strong adhesive tape such as duct tape to ensure the acid stays in the correct spot.  After each treatment, the dead skin is shaved away with a scalpel to get to the deeper skin where the wart is hiding.  This is an effective, painless way to get rid of a plantar wart.  The downside is that it requires consistent office visits over a couple weeks.

Another common treatment for warts is cryotherapy, or freezing the warts.  By using a very direct freezing solution, you can induce a local frost bite on the wart, causing the skin and therefore the wart to die.  Similar to salicylic acid, this is a treatment that needs to be applied several times over a couple weeks.  A common mistake when using this treatment is that the cryotherapy is not applied long enough to penetrate the thick skin of the plantar skin.  In order for freezing to work, the therapy must be applied long enough for the treatment to be painful.  For this reason, podiatrists are using this therapy less and less.

We’ve only scratched the surface of wart treatment.  We’ll discuss some more next post.