An 11-year-old girl complained of pain in her right heel. The pain had been ongoing for several weeks, caused a limp, and at times precluded the patient from performing tumbling maneuvers in cheerleading practice. On physical examination, there was no ecchymosis, edema, or asymmetry compared with the contralateral heel. Medial and lateral heel compression where the calcaneal apophysis attaches to the main body of the calcaneus reproduced the patient's pain, suggesting Sever disease, or calcaneal apophysitis. Radiographs were ordered to ensure that no traumatic injury occurred and revealed a nonfractured bipartite right posterior calcaneal apophysis with increased sclerotic density (image, arrow). The inflammation of Sever disease is self-limiting, and the patient healed over time with increased rest.
Although Sever disease affects individuals differently, researchers have found that children with this disease experience a decrease in quality of life.1 Diagnosis can often be made with clinical findings alone,2 but further evaluation with radiography is advised as a more malignant finding could be overlooked.3
-
Financial Disclosures: None reported.
-
Support: None reported.
References
1 Scharfbillig RW Jones S Scutter S . Sever's disease—does it effect quality of life?Foot (Edinb). 2009;19(1):36-43. doi:10.1016/j.foot.2008.07.004.10.1016/j.foot.2008.07.004Search in Google Scholar PubMed
2 Kose O . Do we really need radiographic assessment for the diagnosis of non-specific heel pain (calcaneal apophysitis) in children?Skeletal Radiol.2010;39(4):359-361. doi:10.1007/s00256-009-0774-y.10.1007/s00256-009-0774-ySearch in Google Scholar PubMed
3 Rachel JN Williams JB Sawyer JR Warner WC Kelly DM . Is radiographic evaluation necessary in children with a clinical diagnosis of calcaneal apophysitis (sever disease)?J Pediatr Orthop.2011;31(5):548-550. doi:10.1097/BPO.0b013e318219905c.10.1097/BPO.0b013e318219905cSearch in Google Scholar PubMed
© 2014 The American Osteopathic Association
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
