An 11-year-old boy who plays football presents with activity-related posterior heel pain that worsens during the sporting season and eases with rest. Examination shows tenderness over the posterior calcaneal tuberosity at the insertion of the Achilles tendon, with no swelling elsewhere and a normal gait. Radiographs show mild irregularity and fragmentation of the calcaneal apophysis. The most appropriate initial management is:

• A Calcaneal apophysis screw fixation
• B Activity modification, heel cushions, calf stretching and NSAIDs ✓
• C Surgical excision of the apophysis
• D Below-knee cast for eight weeks in all cases

Explanation

This is Sever disease, a traction apophysitis of the calcaneus in active children aged roughly 8 to 13 years. It is self-limiting and resolves with skeletal maturity, so treatment is activity modification, heel lifts or cushioned footwear, calf and Achilles stretching, and short courses of NSAIDs. Apophyseal fragmentation is a normal variant and not an indication for surgery. Cast immobilisation is reserved only for refractory severe cases, never as routine initial therapy.

Reference: Tachdjian's Pediatric Orthopaedics, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.