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Thursday, August 14, 2008

Ankle and tendon pain in a teenager

"Hi Gary I have a 17 year old daughter with a foot problem. Whenever she walks on hard surfaces( pavements) for a couple of hours she has a lot of pain in the back of her ankles,seems to be the ligament area.This usually happens during the night after walking around town.

At the moment she is in a lot of pain on the second day after walking around town for a school project. She does not wear proper walking or running shoes when she is in town,just flat school shoes with no support.

So I know this is not good but she still shouldn’t have such a problem. What can I do and who should I take her to see about this.I have taken her to our GP and to a physiotherapist and they can’t see any obvious problem. Would appreciate any help."
Gary Moller replies:
Anna, the problem that you describe is probably the same condition I was troubled with as an active teenage boy. It is most likely that the pain is caused at the point where the Achilles tendon attaches to the heel bone (Calcaneus). The point of irritation on the back of the heel may be felt as a hard, tender bump as can be seen in the photo (My heels look like that; but not quite as pronounced!).

The following assumes that the pain your daughter is suffering is due to the Achilles tendon being under much more tension than before.

During the adolescent growth spurt, the long bones grow at a rate so rapid that the muscles and their tendons get left behind. The loss of flexibility can be dramatic as the muscles are drawn taught as bowstrings: A child that was able to fold oneself in half at 13yrs may be unable to touch his or her shins by 14yrs! This loss of flexibility is most pronounced in boys and it is only in their 20's that there is a restoration of reasonable flexibility.

With this growth spurt there is also an increase in weight which is a further stress on the Achilles and its Calcaneus attachment point. There is a huge increase in the need for nutrients during adolescence; especially for minerals, protein, fatty acids and fat soluble vitamins, including vitamin D from sunlight.

It is during adolescence; especially for girls, that nutrient intake takes a huge dive. The instant noodle, fat-free milk and an obsession with vegetarianism ensure that nutrient starvation sets in.

This lack of quality nutrients will show first of all in the collagen of the body: Skin, hair, nails, tendons and ligaments. Hence the common ailments of adolescence: Bad skin, dandruff, lifeless hair, cracked nails, sore tendons and their attachment points.

Please have a look at my updated Super Smoothie recipe. See if you can get this, or a variation of it, into her daily and you will see a huge difference in a few month's time.

The good news about this injury is there is very rarely any lasting damage and the pain gradually disappears as the growth spurt is completed.

Do you have a question?
Email Gary: gary at (Replace the "at" with @ and remove spaces). Please include any relevant background information to your question.


Anonymous said...

Could it be heel bursitis (a hardening and thickening of the bursa separating the tendon from the heel bone)? I had a lump like the picture back in 1973 caused by irritation of the bursa due to raising my heel inside the shoe and causing it to rub against the hard rim shoes of those days had. It was surgically fixed by chiseling off the knob at the back of the heel bone. High aches accentuated my problem. The surgeon said at the time he had done the procedure on adolesent netballers.

Gary Moller said...

Yes, it sure could be. The photo is not of the teenager, btw.

Anonymous said...

I had it at a teenager and removed when I was in my 20's. It was diagnosed as "Haglund's disease" The docs were able to push achillies to the side and shave down bone spur. With corrective arch supports, It has been 20 years with no pain. Good luck.

Anonymous said...

i having the same issue as this and always having pain when ever i run.. can i know wat the best treatment for this than surgery as my doc ask me to it so? please help.. thank u...