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Calcaneal apophysitis - Sever disease

Case contributed by Dr Paulo A Noronha


Posterior heel pain for 1 month. No history of trauma.

Patient Data

Age: 8 years
Gender: Female

Fat-suppressed T2-weighted images show bone marrow edema within the calcaneal apophysis, extending into the adjacent calcaneal tuberosity, and post-contrast fat-supressed T1-weighted images show contrast enhancement in the same locations. There is also edema around the apophysis as seen on fat-suppressed T2-weighted images. The appearances are suggestive of calcaneal apophysitis (Sever disease).

Case Discussion

Calcaneal apophysitis (a.k.a. Sever disease) is the painful inflammation of the calcaneal apophysis. It is the most common cause of heel pain in athletes between 5 and 11 years. It is caused by repetitive microtrauma induced by the pull of the Achilles tendon on its insertion and is commonly seen in activities that involve running. It clinically manifests as pain in the posterior aspect of the heel that worsens with activity, and occurs bilaterally in 60% patients 1. It must be considered in the differential diagnosis for posterior heel pain in the pediatric population and is primarily a clinical diagnosis 2.

MRI will show edematous changes within the calcaneal apophysis, which may extend into the adjacent calcaneal tuberosity. MRI can also be helpful in excluding other causes of heel pain 2.

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Case information

rID: 63302
Published: 26th Sep 2018
Last edited: 15th Nov 2020
Inclusion in quiz mode: Included

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