What is the diagnosis and recommended treatment for a 10-year-old patient presenting with right foot heel pain, described as throbbing in nature, which worsens with activity and contact, and has improved with use of a walking boot (orthopedic boot)?

From the Guidelines

The 10-year-old patient should continue using the walking boot for one more week during sports and high-impact activities, while gradually increasing time out of the boot for regular daily activities, as this approach has been effective in managing heel pain, particularly in active children, as suggested by the American College of Foot and Ankle Surgeons 1. The patient's symptoms are consistent with calcaneal apophysitis (Sever's disease), a common overuse injury in active children. The fact that the pain is localized to the right foot heel and worsens with activity, walking, and contact, but has improved with rest and immobilization, supports this diagnosis.

• Key aspects of the patient's presentation include:
  • Throbbing pain in the right foot heel
  • Pain worsens with activity, walking, and contact
  • Improvement with rest and immobilization
  • Current pain rating of 0/10, with a maximum intensity of 3/10
• The treatment approach should focus on reducing pressure on the affected area, decreasing activity, and promoting healing, as outlined in the American College of Foot and Ankle Surgeons' guidelines 1.
• Recommendations for the patient include:
  • Continuing the walking boot for one more week during sports and high-impact activities
  • Gradually increasing time out of the boot for regular daily activities
  • Discontinuing pain medication since the patient reports no current pain
  • Wearing proper athletic footwear with good arch support and heel cushioning when returning to full sports participation
  • Starting gentle stretching exercises for the Achilles tendon and calf muscles to prevent recurrence
• If pain returns after discontinuing the boot or increases in intensity, further evaluation with imaging may be warranted to rule out other potential causes of heel pain.

From the Research

Patient Presentation

• The patient is a 10-year-old who presents with right foot pain that started 3 weeks ago
• The pain is localized to the right foot heel and is described as throbbing in nature
• The pain worsens with activity, walking, and contact
• The patient has been using a walking boot and reports improvement in symptoms

Treatment and Management

• The patient's symptoms have improved with the use of a walking boot, which suggests that rest and immobilization may be beneficial in managing the condition 2
• However, there is limited evidence to support the use of acetaminophen for chronic pain conditions, which may be relevant if the patient's symptoms persist 3
• Non-steroidal anti-inflammatory drugs (NSAIDs) and early mobilization have been shown to be effective in reducing pain and improving function in patients with acute ankle sprains, which may be relevant if the patient's symptoms are related to an ankle sprain 2

Rehabilitation and Prevention

• Dynamic stretching has been shown to improve range of motion and muscular performance, which may be beneficial in preventing future injuries 4
• Exercise therapy and bracing have been shown to be effective in preventing chronic ankle instability (CAI), which may be relevant if the patient's symptoms are related to CAI 2
• Walking meditation has been shown to improve ankle proprioception and balance performance in individuals with CAI, which may be a useful adjunct to traditional rehabilitation exercises 5

Medication

• Acetaminophen has been shown to have a strong influence on tendon mechanical and material property adaptations to resistance training, which may be relevant if the patient is taking acetaminophen for pain management 6
• Ibuprofen has not been shown to have a significant influence on tendon adaptations to resistance training, which may be relevant if the patient is taking ibuprofen for pain management 6