https://podiapaedia.org/wiki/paediatrics-2/osteochondroses/calcaneal-apophysitis/
http://www.medbridgeeducation.com/blog/2017/01/severs-disease-current-evidence-based-treatments/
Common – usually 8 to15 years. May be caused by traction from achilles tendon. Pain on palpation of posterior plantar aspect of calcaneus – also lateral pressure may produce pain. Pain initially occurs after activity, then during activity. Can not be diagnosed from x-ray (normal ossification is fragmented and develops from several centres).
Treatment – activity modification and cushioning heal raise; calf muscle stretching. Could also use strapping to hold foot slightly plantarflexed. Orthoses if pronate excessively.
DDx- enthisitis-related arthritis
“all about lever arms in the tall child or compression and all about micro trauma in the heavy child. MRI’s show bone marrow oedema so it probably is some type of stress fracture or something. Then there is the kids that it is both. “
Other Osteochondroses:
Buschke disease | Calcaneal Apophysitis | Diaz (Mouchet’s) Disease | Distal Tibial Epiphysitis | Freiberg’s Disease | Iselins Disease | Kohler’s Disease | Legg-Calve-Perthes Disease | Osgood-Schlatter Disease | Osteochondrosis of Os navicularis | Severs Disease | Thiemann’s Disease | Treves’ or Ilfeld’s Disease
Related Topics:
Calcaneal Apophysis Scoring
This:
Ogden JA, Ganey TM, Hill JD, Jaakkola JI. Sever’s
injury: a stress fracture of the immature calcaneal
metaphysis. J Pediatr Orthop. 2004;24(5):488–92.
“In 2004, Ogden et al. [ 22 ] reviewed a group of
14 skeletally immature athletes with persistent
heel pain for at least 9 months. All had the clinical
diagnosis of Sever’s disease, or calcaneal
apophysitis. An MRI scan was obtained, and, in
each case, it demonstrated edema and hemorrhage
in the metaphysis of the calcaneus, consistent
with the diagnosis of stress fracture. All 14
patients were treated with a cast (3) or a removable
ankle-foot orthosis (11) and non-weight
bearing for 3–4 weeks. In all cases the symptoms
subsided following immobilization, and everyone
was able to gradually resume sports participation
without pain. The authors concluded that
Sever’s disease is a “… chronic (repetitive) injury
to the actively remodeling trabecular metaphyseal
bone that results in a variably sized stress
injury…” and that it is not an apophysitis. This
observation has not been confi rmed by others.”
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