Age / Sex : 9 / M

Calcaneal apophysitis (Sever’s disease)

Discussion

Findings:

[X-ray]

Increased density and fragmentation in left calcaneal apophysis

[MRI]

Slightly high SI with fragmentations of calcaneus apophysis. Bone marrow edema and contrast enhancement in adjacent calcaneus. Mild subcutaneous soft tissue signal changes in heel

Differential Diagnosis:

Calcaneal apophyseal avulsion fracture

Discussion:

[Definition]

An inflammation of the apophysis of the heel

Common cause of heel pain in young adolescent

[Pathology]

Repetitive microtrauma to growth plates of the calcaneus -> Inflammation injury to the calcaneal apophysis associated with muscle strain in the immature skeleton

References:

1. Ozkan Kose. Do we really need radiographic assessment for the diagnosis of non-specific heel pain (calcaneal apophysitis) in children? Skeletal Radiol 2010;39:359-361


2. Yuuki Imai, Toshio Kitano, Keisuke Nakagawa, Kunio Takaoka. Calcaneal apophyseal avulsion fracture. Arch Orthop Trauma Surg 2007;127:331-333


3. Ogden JA, Ganey TM, Hill JD, Jaakkola JI. Sever’s injury: a stress fracture of the immature calcaneal metaphysis. J Pediatr Orthop 2004;24:488–492


4. Leok Lim Lau, Arjandas Mahadev, James HP Hui. Common Lower limb sports-related overuse injuries in young athletes. Ann Acad Med Singapore 2008;37:315-9