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Differential Diagnosis
- Calcaneal apophysitis
- Achilles tendonitis
- Retrocalcaneal bursitis
- Calcaneal stress fracture
- Painful heel pad syndrome (contusion)
Diagnosis
The correct diagnosis is calcaneal apophysitis, also known as Sever disease. Calcaneal apophysitis is characterized as the painful inflammation of the apophysis (growth plate) of the calcaneus, which is located at the insertion point of the Achilles tendon. It typically presents during periods of rapid growth combined with overuse, such as very active younger children and early adolescents that might have started a new activity or sport requiring running and/or jumping. It is more common in boys than in girls and is often bilateral. Calcaneal apophysitis is sometimes associated with high or low arches, over-pronation of the foot, and decreased flexibility in the calf.
What to Look For
- Sever disease is often diagnosed clinically based on clinical scenario.
- On x-ray, increased density and fragmentation of the calcaneal apophysis may be visible
- The patient may walk with a limp, walk on their toes, and have difficulty running and jumping. Pain is worse when walking barefoot
- The patient will likely exhibit pain upon squeezing both sides of the back of the heel
Pearls for Urgent Care Management
- Bilateral use of 5 mm rigid heel cup or lift; eccentric calf strengthening and stretching exercises
- Decreased participation in sports or activities that produce pain, gradually increase activity once pain has improved
- Daily ice application for 20 minutes at a time and NSAIDS for pain management
- Referral to physical therapy or sports medicine if no improvement after 4-8 weeks
11-year-old With Heel Pain While Running
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