Ultrasonography as a Diagnostic Modality in Sever's Disease (Calcaneal Apophysitis)

Abstract

Sever’s disease or calcaneal apophysitis is a common source of heel pain in young athletes. A possible diagnosis of Sever’s disease is generally done clinically. Radiographs are usually taken to assess the ossification of the secondary nucleus, and to rule out other pathologies. In this study we tried to assess the role of ultrasonography in the diagnosis of Sever’s disease. We performed ultrasound examination on 24 children (48 heels) with heel pain clinically consistent with Sever’s disease. 37 symptomatic heels and 11 non-symptomatic heels were examined. All of these heels showed some fragmentation of the secondary ossification center. 24/37 symptomatic heels showed rough fragmentation, which resembled saw-teeth. None of the 11 non-symp-tomatic heels showed such rough of fragmentation. Five symptomatic heels and one non-symptomatic heel also showed fluid in the retrocalcaneal bursa. None of the examined heels showed abnormal findings in the Achilles tendon or in the plantar fascia. In conclusion, sonography has been shown to be helpful in the evaluation of Sever’s disease. We suggest that the sonographic appearance of rough fragmentation with “saw-teeth” appearance can be used as specific sign for Sever’s disease.