From the Guidelines
For an 8-year-old with foot pain, initial treatment should include patient-directed measures such as regular calf-muscle stretching, cryotherapy, over-the-counter heel cushions and arch supports, weight loss (if indicated), activity limitation, and avoidance of flat shoes and barefoot walking, as recommended by the American College of Foot and Ankle Surgeons 1. When managing foot pain in children, it's essential to consider the potential causes, including growth-related conditions, stress fractures, or sprains.
- Initial treatment options may include:
- Regular calf-muscle stretching
- Cryotherapy
- Over-the-counter heel cushions and arch supports
- Weight loss (if indicated)
- Activity limitation
- Avoidance of flat shoes and barefoot walking
- If the pain is mild to moderate, these measures should help within a few days, but if pain is severe, worsening, accompanied by swelling, redness, warmth, inability to bear weight, or persists beyond 3-5 days, consult a pediatrician promptly 1.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may also be considered for pain management, but it's crucial to follow the recommended dosage and consult a pediatrician before administering any medication.
- Proper medical evaluation is essential for persistent symptoms, as children's growing bones and tissues require proper care to develop correctly.
- If no improvement occurs after six weeks, referral to a podiatric foot and ankle surgeon is appropriate, and additional treatments may be considered, including customized orthotic devices, night splinting, or corticosteroid injections 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... Mild to moderate pain: 400 mg every 4 to 6 hours as necessary for relief of pain. The recommended dose of ibuprofen for an 8-year-old with foot pain is not explicitly stated in the label, but for mild to moderate pain, the dose is 400 mg every 4 to 6 hours as necessary.
- The dose should be adjusted based on the patient's response and the severity of symptoms.
- The patient's dose should be reviewed and adjusted as required after a satisfactory response has been achieved. 2
From the Research
Treatment Options for Foot Pain in an 8-year-old
- The primary cause of heel pain in pediatric patients between the ages of 8 and 15 years is Sever's disease, or calcaneal apophysitis 3.
- Treatment methods for Sever's disease include ice, activity restriction, stretching, nonsteroidal anti-inflammatory drugs, immobilization, and heel cups 3.
- Conservative treatment is an effective option for alleviating symptoms associated with Sever's disease, and may include insoles, therapeutic exercises, Kinesio taping, and foot orthoses 4.
- Orthoses may provide greater short-term pain relief than heel raises, although the evidence is limited and further research is needed to establish effective treatment approaches 5.
- Therapeutic options for Sever's disease are mostly conservative, and include rest, physical therapy, kinesiotherapy, and orthoses 6.
Diagnostic Considerations
- Clinical diagnosis of Sever's disease can be confirmed by performing a "squeeze test" of the heel on physical examination 3.
- Diagnostic imaging findings include increased sclerosis and fragmentation of the calcaneal apophysis on plain radiograph x-rays 3.
- Radiographic imaging can help exclude other differential diagnoses 6.
Importance of Further Research
- There is limited evidence to support the use of certain treatments for Sever's disease, and further research is needed to generate higher quality evidence with larger sample sizes and validated measures of pain and function 5, 7.
- Prospective, well-designed studies are necessary to allow confidence in describing Sever's disease and its treatment 7.