Foot-pain

Foot pain is a relatively common problem in children and adolescents. Most frequently the pain is localized at the heel, the mid- and forefoot are less common sites of discomfort. In this article we discuss the etiology of pain in thoses cases, where the foot has a normal clinical aspect. Sever's disease is most common in adolescents with strenuous athletic activity or with obesity. The calcaneal apophysis is overloaded. Usually the radiologic aspect of the calcis is normal. Treatment consists in reduction of the athletic activity, soft bedding of the heel in the shoes and reduction of weight. Avascular necrosis of the metatarsal head II or III (Freiberg's disease) is also relatively common, while necrosis of the navicular bone (Köhler's disease) is very rare. Treatment in these cases is always conservative. Pain can also originate from tarsal coalition. While in the beginning the foot has a normal aspect, lateron a rigid flatfoot can develop. In unclear cases stress fractures of the metatarsal bones, infections and tumors also have to be considered.