with Margot Manning, Podiatrist, running coach, and a mum.
Heel pain in children, often called Sever’s Disease, is one of the most common injuries experienced in active kids today. Heel pain usually occurs because of the repetitive loading with active play. The vertical attachment of the achilles tendon to the back of the heel bone (calcaneus) is right where there is a large bone growth plate.
The growth plate is the area where new bone cells are generated and is present until between the ages of 13-16 when children stop growing, and the bone fuses, to make the completed heel bone. During this time, running, jumping, kicking and rapid changes in direction that children do while playing sport exert an incredible amount of sheer force and pulling onto the growth plate. This pulling can create soreness which can be quite debilitating for children and interfere with their ability to play without pain. Being aware of this process enables you to take a few steps to minimise the chance of your child developing heel pain.
Early detection of heel pain and being proactive can reduce the severity of heel pain and help your kids get back to being kids and enjoying being active. Below are three of the most successful management strategies for treating heel pain in kids.
4 Tips to manage and minimise the onset or severity of Sever’s Disease:
Fit their shoes properly – Get the right size
Teach your kids HOW to put their shoes for play
Match the right shoe for their feet needs
Change their shoes regularly
Get the right size… Make sure their shoes fit properly 2. Teach your kids HOW to make their shoes fit to play, 3. Match the right shoe for their feet needs 4. Change their shoes regularly
If heel pain catches you out, don’t worry come and see us to creating a management plan to help both you and your child know what to do before and after playing sport.
Have you noticed any of the following with your child?
Limping when walking or when active
Favouring one leg over the other
Adversity to activity due to pain in the heel
Complaints or comments about soreness in the heel
If you are unsure whether your child has Sever’s Disease, or have noticed any of the above symptoms it is time to take action. Don’t let your kids suffer in pain any more. Our team of podiatrists and physiotherapist at the intraining Running Injury Clinic can help diagnose, assess and provide management strategies to help your child return to activity – pain free.
Make an appointment to see one of our podiatry team today. Often there is minimal out of pocket expense with private health cover claimable on the spot. We recommend you bring all your child’s shoes with you to the appointment so these can each be assessed and possibly modified to help relieve pain.
To make a booking call intraining Running Injury Clinic on 07 3367 3088 or click the button below to make an appointment online.
It is very easy as parents to live vicariously through our children’s performances. It is tempting to think that it is a reflection on our parenting. The reality is that kids will often do the best in the long term if we get out of their way and just support them with whatever they accomplish. By exerting overt or subtle pressure on them we can spoil their love of running and drive them away from reaching for their potential.
However short-term results are often what we are excited about as athletes and parents. It takes patience and planning to be the best we can be at the right time. The journey towards excellence passes by the early developers and burnt out over trainers.
Is winning at an early age a good thing in the long term?
Developmental ages for children vary extensively. In general girls mature earlier than boys but within a gender the variance can be many years. Early developers gain a confidence boost by easily beating late developers early on. However in the long run there is some evidence that it is physically better to develop as late as possible.
For psychological reasons it can be better to excel when older. Kids who are winning nationals in grade 4 when they first compete often are not participating by grade 12. Early success can sometimes cause complacency and then frustration when later developers start to catch up. Late developers have to initially struggle and deal with losing which builds resilience and persistence. Tactical skills are honed with tough races rather than easy wins.
In my experience over many decades as a running coach I believe that hard training at a young age is not beneficial to children’s long term development as a distance runner. However I can accept that hard training in upper primary school may be of value if a child is trying to attain a sporting scholarship for high school. This will be at the possible cost of their long term success but could save parents many thousands of dollars. That is a value judgement that the parent and child must make.
Can running physically damage my child?
Parents often worry about damaging growth plates in children with too much running. While active kids are more likely to have growth related injuries like Osgood’s of the knee and Sever’s at the heel the only evidence for growth plate damage is with maximum power resistance training. Children may have less capacity to train in the heat than some adults due to surface to volume ratios. Because they have less experience they are unlikely to be able to train long distances as it can take years to safely progress total weekly mileage. Like with adults overtraining can lead to injury, illness or burnout.
What does hard training involve?
To achieve early success requires frequent intense speed sessions. Total training load or distance covered has a reduced cost benefit especially for pre-pubescent children. That is the more kilometres they run the lower the quality of their race performances will be. So if your goal is for your primary school child to race at their best at a young age then the focus should be on speed sessions rather than mileage. I always tell my athletes that they should aspire to be running at their best in grade 11 and 12 and to be patient when they hear their peers are doing long intense speed sessions. While they may not be as competitive in primary school and early high school in the long term they will be better off.
What are the guidelines?
The Australian Sports Medicine Federation’s Children in Sport Committee (ASMF) recommends conservative guidelines “in the absence of evidence of the detrimental effects on children training for distance running”. These guidelines recommend maximum race distances of no more than 8km at age 12 to 14 and half marathons at age 15 to 16. They recommend weekly maximum training distances of three times their competitive distances. Interestingly there is no recommendation about the amount of intensity that is appropriate at different ages even though that is the more likely cause of training burnout and a child leaving the sport.
For a girl racing cross country at age 14 over 4km that is only 12km. Even if you used their 8km maximum race recommendation that would be only 24km a week. Even at a slow 6 minutes per kilometre that would only be just over 2 hours a week. In comparison with other sports like gymnastics and swimming this is not even the amount an elite junior would train daily at age 14.
Should a child run long and slow?
Long slow running benefits children in the same way it does adults: by Improving heart stroke volume and aerobic efficiency (to transport oxygen to muscle); by increasing the capillary network (that delivers the oxygen); and by increasing myoglobin concentration and the number and size of mitochondria so that muscle fibres can use the oxygen when needed. The result is a higher MaxVO2 and better lactate clearance rates. Children who run long and slow will not learn to push for long at their maximum speed but they will feel much easier at close to their maximum compared to their intensity focused peers.
Haile Gebrselassie reported that he ran 10km to school every day carrying his books. His daily running distance was more than the suggested weekly maximum guidelines by the ASMF. I do not think it would be an exaggeration to say that no Australian child runs as much as he did. We are so worried about children training too much that I wonder if
our conservative guidelines are preventing our children from achieving their maximum potential as adults.
Children vs adults
Ever since legendary coach Arthur Lydiard started the running boom in the 60’s, distance running training principles for adults have started with base training of easy running followed by the gradual introduction of specific intensity. Why don’t we let our children follow the same proven pathway to performance success? I believe that part of it is the climate of overprotectiveness in society. Children can not be left home alone if they are under 14. Very few kids make their own way to school by walking, running or cycling. This then expresses itself by always following the short term conservative approach to childhood risk. The result is skyrocketing obesity rates in children and they may be the first generation that does not live as long as their parents.
Who do the guidelines target?
Athletics officials are concentrated on the success of elite athletes and their transition from talented children to medal winning adults than they are of the health of society. But very few children will ever achieve elite success as an adult.
The great benefit of running to the vast majority of people is improved health and longevity. Long easy running develops a lifelong love of running while intense speed sessions often create a hatred of hard training as evidenced by the number of previously elite young adults who quit exercise as soon as they finish school.
My recommendation for children’s training loads
My recommendation “in the absence of any evidence of the detrimental effects on children training for distance running” is to drop the current guidelines around maximum distances of racing and training. Instead research should be conducted on safe levels of intensity involving number of intense sessions a week, the total volume of intensity and the proximity to maximum effort in training.
An easy run is like a meditation session. You get into a rhythm and enter a zone of peace and clarity. Before you know it your run is over and the physical and mental benefits are obvious in the afterglow. This is what creates a love of running and a lifetime habit of health and exercise. This is what should be the focus of running as a child. If they do go on to become an elite athlete then this love of running will be a great base to launch their career. Even if they don’t become elite the benefits of learning a love of running early on will continue for the rest of their lives.
If you think your child may be over-reaching and may be heading towards burnout, make an appointment for a FREE 15 minute consultation with one of our experienced running coaches who can help nurture and guide your child to long term success and ultimately enjoyment of running. Click the button below.
About Steve Manning
Steve has been coaching children for 35 years since he was 18. He has coached multiple national champions in cross country, athletics and the triathlon. His favourite achievement as a coach is when three of his athletes swept the places in the 3000M national schools championship.
He coaches an elite junior squad on Thursday mornings and is available for individual coaching programs through the intraining Running Injury Clinic. Steve is a podiatrist and sessional academic for fourth year podiatry in sports medicine and paediatrics at QUT. Steve is the current chairman of the Sports Medicine Australia Queensland Council and is a past chairman of the board.
Not a promising statistic – according to Sports Medicine Australia, up to 70% of runners suffer an injury each year. Age is a known contributor to injury risk, and significantly influences the types of injuries that runners are likely to suffer. Whilst children often seem like invincible energiser bunnies, they too can be sidelined due to injury, particularly if they’re doing high volumes of training.
In general, children will recover more quickly from injuries, and the prolonged recovery time is a common frustration for older runners. However, this does not mean that the injuries children suffer are any less damaging. In fact, if poorly treated, serious childhood injuries can significantly impact their growth and development, and taint their passion for running for months or even years to come.
Efficient and injury-free running relies on a synergy between the muscles, ligaments, tendons and ligaments. Injury commonly targets the weakest link in this chain, which differs for adults compared to children, and is influenced by other factors including running history, body composition, biomechanics and running gait.
Bone growth occurs throughout childhood and adolescence. During development the growth plate is weakened, and thus prone to injury. Children are at higher risk of such injuries for approximately 6-12 months within a 3-4 year window, with susceptibility varying depending on the bone/region in question. Growth plate injuries (Apophysitis) are more common in active children. These growth-related injuries resolve with time, but treatment should be undertaken to reduce pain and manage the injury to ensure it doesn’t cause permanent damage. Common examples of Apophysitis injuries include:
Activity modification and load management are important when treating Apophysitis injuries. Treatment should also address contributing factors and biomechanical issues to assist in pain and symptom relief. For example, Sever’s can be successfully managed with many strategies including regular icing and the addition of heel lifts to all shoes to reduce strain on the Achilles tendon and posterior heel.
The soft tissue structures in children are much more pliable and more resistant to injury. Therefore, muscle and tendon injuries are much less common. Young bones are also more flexible and less brittle, so they too are more resistant to injuries, and stress fractures in particular are unusual injuries for children. Fractures are not uncommon, but in most cases they result from acute trauma. As with adults, unusual injuries such as cancerous tumors and systemic conditions are not out of the question – hence it is always important to seek professional advice.
Be aware that active children are likely to suffer an injury at some point, whether it be due to training or a traumatic event. Even though their pain may be inconsistent, or their symptoms may be different to those experienced by adults, their injuries should not be ignored.
Serious injury can lead be detrimental to their long-term health and well-being, so they should be given the same treatment opportunities as adults to ensure their injuries are diagnosed and managed as efficiently as possible. A good pair of correctly fitted running shoes will certainly help avoid injury – read the article why here.
If your children are experiencing any pain or discomfort whilst running or in their day to day active lifestyles, it is time to make an appointment at intraining Running Injury Clinic to see one of our podiatrists or physiotherapists. If you have private health cover, you are able to claim on the spot with minimal out of pocket expense. Don’t ignore the problem, get it seen to sooner rather than later.
Your children’s footwear is a priceless investment in their future. It’s important to purchase good quality shoes, and also ensure they are well-fitted.
Spending the time and money on your children’s feet and footwear during their younger years will reap many benefits throughout their schooling years and even into adulthood. Wearing good footwear will reduce their risk of short and long-term injury, and save from unexpected, expensive health practitioner bills.
Fit is the most important factor to consider, and you should seek out footwear stores with experienced fitting staff. Even if your child has the best shoes available, if they don’t fit properly then the benefits will be negligible. Your child should be able to try on the shoes, and the staff should provide comprehensive, sound, and unbiased advice. Your child will be much more likely to become involved and enjoy their physical activity if they’re wearing comfortable shoes. In this way, properly fitting shoes can provide benefits to your child’s physical and mental well-being. Ill-fitting shoes can cause discomfort for your child, and may also increase injury risk.
Put simply, big shoes are a trip hazard and therefore increase the risk of acute injury (eg. ankle sprain). Excessive muscle activation and overuse injury can also occur if your child is trying to stabilize their feet inside shoes that are too big and providing insufficient support or security. Jamming your child’s feet into shoes that are too small is also detrimental. Discomfort is the most common complaint when shoes are too small, but burning pain and tingling may also be an issue in cases of nerve or vascular compression. Blisters, black toenails and other dermatological issues can eventuate from shoes either too big or too small.
Just like obtaining the proper fit is important, good quality shoes are worth the investment. Well-constructed shoes will be more durable and offer more reliable support and cushioning.
Shoes worn every day for school should ideally be used for that purpose only. Shoes with a leather upper are ideal because they are more durable and will withstand the rigors of lunch playtime.
If your child is a keen runner, you should treat them to a pair of running shoes. Running shoes will offer superior midsole cushioning and reduce the risk of overuse and impact-related injuries. The lighter-weight materials and breathable mesh upper will make you child’s running easier and more enjoyable.
Similarly, if your child plays a lot of field sports, then grass spikes or football boots may be worth considering. They will provide better traction and more appropriate support for their intended use. Having multiple pairs of shoes for different purposes will prolong their life.
intraining Running Centre stock a fantastic range of children’s running shoes, waffles and spikes, as well as black leather shoes suitable for school use. Invest some quality time and money on your kids school and running shoes at intraining Running Centre these holidays and ensure your children are ready to run into 2017.
By Emily Donker intraining Podiatrist, Runner and Coach
Knee pain is a common injury affecting one third of adolescents and causing disruption to their sports training & performances. (Rathleff et al, BJSM, 2015) The most common knee injury is Patella Femoral Pain Syndrome (PFPS). Girls are affected more than boys and adolescent girls are also affected with ACL injuries 2-10 times more than boys. (Myer, 2013).
Myer’s research paper also suggested that one of the major differences between girls & boys during a landing task was the overactivation of the quadriceps with decreased hip flexor activation in girls. This led to an increase in rotational forces at the knee, called knee abduction moments. Knee Abduction moments appear as a movement of the knee inwards or internally rotating over the planted foot. (see image) This is clearly visible during landing in volleyball, netball, and basketball.
Sports that involve cutting movements such as football and touch increase the force of Knee Abduction Moments (KAM) due to the higher speeds of landing and rotation in a single leg stance. The greater the increase in the KAM, the greater the risk of PFP & ACL injuries.
During maturation, boys had shown to have the opposite muscle activation to girls with an increased hip flexor activation. This higher activation of hip flexor muscles in the body could potentially balance the quadriceps activation & limit rotational forces at the knee. Myer also suggested that during maturation phases, girls with increased height and mass are more prone to earlier onset of PFPS.
Based on these findings and on the more widely known understanding of quadriceps involvement, students who are experiencing PFPS need to undertake a quad strength, and neuromuscular exercise plan. Most of these students will respond well to a specific & individualised program designed by a qualified health professional. They also need to relearn jump landing strategies, cutting movements, and single leg movement patterns for their sport. Sometimes other interventions such as footwear, and added support such as orthotics may be required if there are more specific anatomical and biomechanical issues.
A recent paper published this year in the British Journal of Sports Medicine found that additional exercise sessions done at school helped increase the recovery time for PFPS in adolescents. (Rathleff, 2015). These can be conducted by the sports educator / trainer as part of the warm up routine with the team. FIFA have thoroughly researched ways to reduce injury risk and have produced an exercise routine called FIFA 11+ that is readily accessible online.
As sports educators, coaches and trainers are usually the first person to recognise injury and or complaints of pain by adolescent sports girls & boys. It is worth talking to the students, and referring them for further investigation with the view that they will be given an appropriate strength program. Further helping them at training by including their exercises into the warm up routine is more likely going to keep your players on the field for longer and hopefully performing without pain, or with less pain throughout the season.
At intraining, we have a team of health professionals including podiatrists & physiotherapists who are experienced in treating sports related biomechanical injuries. Our clinicians understand the need to help students cope with the high loads of sporting commitments and injuries they experience. If you wish to discuss any concerns regarding injuries please contact us here.
Written by Margot Manning Podiatrist, Level 2 Athletics Coach, Runner & Owner of intraining Running Centre intraining Running Injury Clinic
1. Rathleff, M., Roos, E.M., et al. Exercise during school hours when added to patient education improves outcome for 2 years in adolescent patellofmoral pain: a cluster randomised trial. Br J Sports Med 2015; 49:406-412
2. Myer, D., Ford, K., et al. high knee abduction moments are common risk factors for patellofemoral pain(PFP) and anterior cruciate ligament (ACL) injuries in girls: IS PFP itself a predictor for subsequent ACL injury? Br J Sports Med 2015; 49:2 118-122
3. FIFA 11+
Childrens feet and the shoe fit
By Margot Manning (podiatrist & coach)
The temptation when purchasing children’s and teenager’s shoes is to allow for growing room. While this appears more cost effective at the time, the extra room in the shoes could lead to unwanted movement and the development of injuries. The purpose of a well fitted shoe is to grab the foot firmly so that the two units (foot & shoe) move together as one piece. When there is a mismatch in shape or size, the muscles and tendons required to ‘control’ the movement will fatigue sooner.
Primary school children’s running shoes do not usually have half sizes. This does mean that often they need to go to a larger than ideal shoe fitting. In this situation a more shapely insole, or added padding to the existing insole can work well to fill out the shoe. A heat mouldable insole (not an orthotic) can customise the shoe even further to suit the varying shapes and sizes that children and teenagers feet present.
The retail staff at intraining Running Centre can help with shoe fitting and customising the shoe with insoles, but if you are a little more concerned about your childrens feet, make a booking to see one of the podiatrists.
At intraining Running Injury Clinic our podiatrists help diagnose and treat running related injuries to get you back to doing what you enjoy.
All of our podiatry team are avid runners and/or triathletes at the clinic and understand how frustrating it can be having an injury.