Calcaneal apophysitis (Sever disease)
It typically presents between 8-14 years. It is rare after this age as the calcaneal apophysis should fuse around 15 years. It is commoner in more active children, especially in weight-bearing sports e.g. running, dancing.
Patients may also have:
- Pain on ankle dorsiflexion, especially on active toe raise
- Mild heel swelling
- Calcaneal enlargement
- Only if chronic which is rare
Investigations are largely used to exclude alternative diagnoses. These include:
- X-ray to exclude fractures or tumour
- X-rays findings may be normal or non-specific sclerosis.
- CT/MRI can be used to exclude osteomyelitis.
Red flag features suggestive of an alternative diagnosis include significant rest pain, night pain or large swelling.
- Avoid sports for 2 months
- Can consider continuing non-weight bearing activities
- Physiotherapy including stretching exercises
- Footwear advice
- Heel pads
- Consider NSAIDs in severe cases
- Rarely needs an orthopaedic referral