An 11-year-old boy presents with 6 weeks of activity-related heel pain in both feet after joining school athletics. He walks with a mild limp after running, and firm pressure applied to both sides of the posterior heel reproduces his exact pain. There is no swelling, erythema, or morning stiffness. Radiographs show increased density and fragmentation of the calcaneal apophysis. What is the diagnosis?
- A Calcaneal apophysitis (Sever disease) ✓
- B Plantar fasciitis with calcaneal spur
- C Reactive arthritis following enteric infection
- D Osteoid osteoma of the calcaneus
Correct answer: A. Calcaneal apophysitis (Sever disease)
Explanation
Sever disease is a traction apophysitis of the calcaneal tuberosity at the Achilles insertion, typically in active children aged 8 to 12 years. Bilateral pain, a positive medial-lateral heel squeeze test, and fragmentation of the apophysis confirm it. Plantar fasciitis causes pain at the plantar surface origin rather than the posterior apophysis, and reactive arthritis produces swelling and stiffness rather than pure squeeze-test tenderness.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.