A 9-year-old boy presents with insidious onset heel pain, worse with running and jumping activities. He is tender over the posterior calcaneus. Radiograph shows sclerosis and fragmentation of the calcaneal apophysis. The most appropriate management is:

• A Surgical debridement of the calcaneal apophysis
• B Long leg cast immobilization for 6 weeks
• C Intra-articular corticosteroid injection
• D Activity modification, heel cups, stretching, and NSAIDs ✓

Explanation

This describes Sever's disease (calcaneal apophysitis), a self-limiting traction apophysitis of the calcaneus in skeletally immature children aged 8-12 years. Treatment is conservative: activity modification, heel cups/raises to reduce pull of the Achilles, stretching, and NSAIDs. Surgery is never indicated. Casts are rarely needed and reserved for severe cases. Corticosteroid injection is contraindicated due to risk of subcutaneous atrophy and is unnecessary.

Reference: Rockwood and Wilkins' Fractures in Children, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.