Watch for Overuse Injuries The annual rite of returning to school often includes signing up for soccer or other sports. Today, many children and adolescents play more than one sport in the same season or compete on “travel” teams that practice daily and play in tournaments almost every weekend.    All this activity can place excessive stress on young feet that aren’t yet fully developed. Playing soccer and other sports that involve a lot of running on hard surfaces can lead to “overuse” injuries typified by stress or damage to growing bones, tendons and ligaments.  Never allow a child to play with pain , despite impassioned protests and what coaches and teammates might say. Foot pain isn’t normal. If it lasts more than a few days and interferes with walking, seek medical attention. Playing with pain is risky.  It can lead to chronic and painful foot and ankle conditions and downstream problems with the knees and lower back. Common problems that can result from too much sports activity include: Achilles tendonitis: The long tendon that connects the heel bone to the calf muscle becomes inflamed.  Calcaneal apophysitis: Repetitive stress and muscle strain in the growth plate of the heel cause inflammation.  Plantar fasciitis: The band of tissue that runs along the bottom of the foot from the heel to the toes gets inflamed and causes heel pain.  Stress fractures: Repetitive pounding on foot and ankle bones causes hairline breaks. Tendo-Achilles bursitis: The fluid-filled sac between the Achilles tendon and the heel bone becomes inflamed.  For example, heel pain occurs frequently in children ages 6 to 14 as their feet grow and the heel bone develops. As children get active in competitive sports, they increase their risk for growth-plate injuries and subsequent heel pain.  New bone forms in an area behind the heel, known as the growth plate, and cartilage is vulnerable to severe inflammation from strain or stress. With repeated stress from over-activity, the heel becomes very painful. Even though growth-plate trauma is the leading cause of heel pain in children and adolescents, the condition sometimes is difficult to diagnose. Parents should be concerned if a child has pain in the back or bottom of the heel, limps, walks on the toes, or seems to have difficulty participating in normal recreational activities.  To achieve an exact diagnosis, podiatric foot and ankle surgeons thoroughly examine the child’s foot and leg and often take x-rays.  Tips for Avoiding Overuse Injuries Get the right shoes for the right sport. For example, basketball shoes have more ankle support for lateral movement than running shoes, which are better cushioned to stabilize the foot and withstand persistent stress on the track. Never let a child wear hand-me-down shoes, despite the attractive cost savings. Before buying athletic footwear, be sure that shoes are well constructed and don’t bend in the middle of the sole. Have them fitted professionally. Never wear cleated shoes on surfaces other than playing fields. They put too much pressure on the sole of the foot. Be sure the level of competition is within the child’s ability and overall stamina. Help overweight children lose excess pounds. Being too heavy puts excessive pressure on the feet.