Growing Pains: A Real Pain in the...Leg!

by Christina Johns, MD, MEd

I never really know what to say when people talk about “growing pains.” It kind of sounds like some vague non-condition that our old great-aunt said no matter where we were hurting as kids. And it means something different to everyone—is it just in the legs? All over? Does it last for years? Is there anything that can be done about it?

Growing pains in kidsMy daughter who is 9 complains randomly, yet frequently, that her legs hurt. All over. With no apparent trigger and no obvious relief except muscle massage (good strategy and you can be sure if it gets me a leg massage I’m gonna try to claim this myself). There are a few ACTUAL medical conditions that are in that “growing pains” category—and in the spirit of great-aunts everywhere I thought I’d take a moment to bring them up for discussion.

So today let’s hit growing pains IN THE LEGS, from the bottom up. In my professional (and current personal) experience, that’s the most common place where kids describe this vague, varying, hard-to-figure-out pain. The hallmark of these growing pains is that there’s typically no single trauma or fall or twist or anything that can really be identified as the cause, per se.

Heel Pain

If the HEEL seems to be the most painful area, it might be Sever’s Disease, otherwise known as calcaneal apophysitis (25 cent word! No — more than that – at least 75 cents). This disorder happens when there is inflammation of the growth plate in the heel. Why does this inflammation happen? The growth plate is where bone growth happens and cartilage changes into bone. Sometimes the bone grows more rapidly than the tendons and muscles. As a result they get tight and stretched out, putting pressure on the growth plate of the heel, causing the inflammation. Sever’s Disease happens most commonly in kids who are very physically active on hard surfaces and during the period of most rapid growth spurt. It can be made worse if a child is overweight, has a flat or very high arch, or a foot that rolls inward when walking (this is called pronation).

Heel PainKids with Sever’s Disease describe a variety of symptoms. Obviously, pain is the hallmark, especially when the heel is squeezed, but they often describe stiffness too, worse upon awakening and after activity. Sometimes the heel can look red. This can be quite dramatic and affect the way the child walks. Most of the time the diagnosis is made without any xrays or other tests: just a good old fashioned clinical evaluation. The history and physical examination tell the whole story, but occasionally an xray of the foot and/or ankle may be obtained to make sure that something like a fracture is ruled out.

The treatment for Sever’s Disease and most growing pains is REST and pain control. Annoyingly, there’s no magic fix for this one. Rest helps to relieve the pressure on the heel and thereby decrease the inflammation that we talked about earlier.

So is there ANYTHING else that can be done besides rest?

Yes. All the supportive care routine applies here: Ice, Compression, pain medicine (like acetaminophen or ibuprofen), and stretching. Even if your child is disciplined about this, it can take two weeks to two months for this to go away, and it can recur if the heel isn’t protected well during growth, and that means supportive shoes. What I mean by this is shoes that have good support and padded heels. Sometimes shoes without backs (like clogs, but what kid wears those?) can help since they don’t rub against the back of the heel. If there’s any good news about this condition, it’s that it nearly universally goes away by the time the growth plate closes and finishes growing, typically by the age of 15.

Moving up, let’s talk about SHIN/KNEE pain.

Another common growing pain with a fancy name: Osgood-Schlatter Disease (50 cents). Not really a disease at all actually, because it’s the same temporary condition with inflammatory mechanism just like Sever’s Disease above. This one usually occurs right at the top of the shin where the kneecap joins it. Often only one leg is affected. Risks are similar to Sever’s Disease as well: when there’s a growth rate discrepancy between muscles, tendons and bones anywhere in the body this type of inflammatory process can occur. There’s a wide spectrum of pain on this one: some children have very mild, short term pain while others can be quite tender for a period of months. Treatment is supportive: all that same rest, ice, stretching stuff still applies. Isn’t it some weird irony that the kids who are most active and LEAST likely to be good about resting, get these conditions? Ahhhhh, strugglebus.

Can growing pains occur in other body parts?

Of course. Anywhere there’s muscle and bone growth as well as increased use has the potential to get inflamed. One thing I want to stress before we call our great-aunts and validate them with actual names of growing pains is when to be concerned that there’s potentially something MORE SERIOUS GOING ON than just growing pains.

Things to look out forHere are some things to look out for:
• If your child has experienced a specific fall or trauma.
• If your child is only tender in one fingertip-width area (called point tenderness).
• If your child has an odd rash overlying the area
• If your child has a fever or other signs of systemic illness, then one of these simple “growing pain” type illnesses are less likely and will warrant prompt evaluation by a clinician.

While I now give my daughter the hairy eyeball when she starts in with an overly dramatic representation of her leg pain (Academy Award-worthy), I will tell you I did that only after I made sure that there really wasn’t anything else going on. Now, when she complains, I dutifully give her an ice pack, rub her calf muscles, occasionally fire up the ibuprofen, and watch her wait it out. Before long, she’s back in action and available to give her 11-year-old brother a swift kick in the pants. With the affected leg. Carry on, friends.

Dr. Christina JohnsChristina Johns, MD, MEd is the Senior Medical Advisor at PM Pediatrics. As a parent, pediatrician and pediatric emergency physician with a master’s in education, she shares her own expertise, plus the wealth of knowledge from our highly skilled staff, with patients and families everywhere.

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