The Achilles tendon connects the heal bone to the calf muscles. It is the largest tendon in the human body, used for walking, running and jumping. Rarely does a pediatric patient, under the age of 14, have problems with tendinopathy, or rupture of the Achilles tendon, but a variety of conditions involve secondary involvement. Such conditions can be congenital, developmental, traumatic or neurological. Congenital means present at birth.
Congenital
Club foot occurs in two out of every 1,000 live births. Abnormal Achilles tendon shortening is secondary to this foot deformity. Surgical release or lengthening is necessary to correct the problem.
The Achilles tendon is contracted with rocker-bottom foot, or vertical talus. In this deformity the tendon is surgically released and the joint relocated. Post-surgical casting and physical therapy follow.
Developmental
Sometimes Achilles tendon tightness occurs with developmental foot disorders. In rare cases, pediatric flatfoot coincides with a shortened Achilles tendon. Surgical bone shortening and Achilles tendon lengthening corrects the deformity and relieves the painful symptoms. Other developmental disorders associated with Achilles tendinopathy include lower extremity malalignment, leg length discrepancy and muscular weakness.
Sever's Lesion
Sever's lesion is due to trauma. It is a common cause of heel pain in children over 10 years old, during years of excessive growth. Microtrauma to the child's growth plate, located behind the heel, causes the pain. High-speed sports provoke this condition as the Achilles tendon pulls the bone away from the growth plate. Rest and anti-inflammatory medications are recommended. Also, proper warm-up exercises, good shoes and heel inserts prevent symptoms.
Overuse Injury
Achilles tendonitis, inflammation of the tendon, commonly occurs from activities requiring repetitive running, jumping or leaping. Sports sharing frequent over-use injuries include running, gymnastics and dance. Lower leg and heel pain is worse during sport activities and when using stairs. These types of injuries can be avoided by careful physician analysis of training sessions and equipment. Rest, ice, anti-inflammatory medications and calf muscle stretches treat Achilles tendonitis.
Neurological
Cerebral palsy, spina bifida, poliomyelitis and muscular dystrophies are included in neurological associations of Achilles problems in children. Normal walking gait requires three rocker positions of the ankle and foot. The Achilles tendon is required for proper push-off during the gait. In cerebral palsy and spina bifida Achilles tendons are contracted and require surgical lengthening. In polio certain muscles are paralyzed and tendon transfer surgeries are recommended. Progression of muscular dystrophies may require both surgical tendon transfer and tendon lengthening.
