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child back of heel pain

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Our nearly 7 year old boy,about 6 weeks ago reported that the back of his right heel hurt. It was painful if you pushed on it in a spot about the size of a dime. It did not hurt to squeeze his foot on each side of the achilles.
He walked with a limp and would not walk heel toe. he would walk withhis right foot outward at about 45deg.
We had the foot xrayed..no broken bones.
We took him to orthop surgeon who said achilles was fine and he put foot in a cast for 3 weeks.
When the cast ws removed he was better.. the back of heel was not as painful to the finger pressure test and he could flex his foot more freely but is was still painful and he is still walking with a limp and his right foot facing outward 45deg.
Any ideas of cause or treatment?

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  1. Calcaneal apophysitis or inflammation of the growth plate is common in active children until the growth plate in the heel bone finally closes down (around 14). I always x-ray both heels and do a careful comparison. Fractures of the growth plate can occur. Also (although more rare) the blood supply to the growth plate can get disrupted and the bone needs to be immobilized until new blood supply regrows.The casting may not have been in place long enough. If he had a cast boot, then it might be as simple as putting him back in it. Having said all of this, I can not be certain of any of the above, as I have not examined him.

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