Recently I had a conversation with two well-known sports editors on the subject of cleated shoes and how the shoes can affect the heel of the foot.

The concern is for the young athletes. Cleats are not supportive and may cause increased pressure on the heels, the Achilles tendon and the arches of the feet. The more an athlete plays their respective sport, the more stress and strain is put on the joints, especially on the growth plates of young feet.

Long-term complications may exist as the young athletes get older. If there is an injury, it can affect the bone growth due to the needed blood supply to the growing bone tissue.

According to surveys, heel pain is the leading foot ailment affecting Americans both young and old. In the young age group, the pain is usually present in the back of the heel and is more pronounced in running and jumping sports. Sometimes there is a limp in the child's gait, of which he may not be aware.

In addition to the trauma and stress created by running and jumping in sports, or even distance walking for exercise, there are other contributing factors that result in the inflammation of the growth plate or adult heel pain. These include biomechanical foot imbalances of abnormal pronation--inward rolling of the feet--or a high arch foot.

Early treatment is a must, especially in the younger age group. Treatment should include X-ray evaluation to make a proper diagnosis and to rule out any bone fractures. In many cases, conservative therapy with an orthotic insert is needed to correct the biomechanical imbalance and shock absorption that could lead to a jamming effect on the heel plate. In addition, eliminate the use of any cleated shoes with less than four cleats in the heel area.

Dr. Robert Weiss lives in Westport and has a sports-podiatry practice in Darien. He is a former marathon runner and was a member of the Medical Advisory Committee of the 1984 and the 1988 Olympic Trials.