Age / Sex : 9 / M

Chief complaint : Six-week history of pain in the posterior aspect of the right heel.
                          - with limp and intense pain when jumping.

What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer)

Courtesy : 이로운 (Ro Woon, Lee), 인하대병원 (Inha University Hospital)

Sever’s disease (calcaneal apophysitis)

Discussion

Findings
The X-ray shows increased density of the right calcaneal apophysis, and radiolucent lines through the apophysis indicating fragmentation.

Discussion
Sever’s disease or calcaneal apophysitis is an inflammatory condition of the growth plate of the heel bone and is due to repetetive microtrauma by traction on the adhesion site of the Achilles tendon to the calcaneal tuberosity.
The X-ray shows an increase in the density with fragmentation of the calcaneal epiphysis (radiolucent line of the epiphysis).
These finding are not specific and could be present in patients without symptoms.
The x-rays may not be needed for reaching at diagnosis, but x-ray findings do help to exclude other causes of heel pain.

References
1. Sever JW: Apophysitis of the Os Calcis. New York Medical Journal 1912; 95: 1025-1029.
2. Beck L, Heindel WL. [Apophysitis calcanei]. Rofo. 2012;184 (11): 973-5. doi:10.1055/s-0032-1318952 - Pubmed citation
3. Tu P, Bytomski JR. Diagnosis of heel pain. Am Fam Physician. 2011;84 (8): 909-16. Pubmed citation