Clinical Images  |   May 2014
Sever Disease (Calcaneal Apophysitis)
Author Notes
  • From the Department of Radiology at the West Virginia University School of Medicine in Morgantown 
  • Address correspondence to Christopher W. Bailey, DO, West Virginia University Department of Radiology, Room 2278 HSS, PO Box 9235, Morgantown, WV 26506-9235. E-mail:  
Article Information
Imaging / Neuromusculoskeletal Disorders / Clinical Images
Clinical Images   |   May 2014
Sever Disease (Calcaneal Apophysitis)
The Journal of the American Osteopathic Association, May 2014, Vol. 114, 411. doi:10.7556/jaoa.2014.081
The Journal of the American Osteopathic Association, May 2014, Vol. 114, 411. doi:10.7556/jaoa.2014.081
Web of Science® Times Cited: 3
An 11-year-old girl complained of pain in her right heel. The pain had been ongoing for several weeks, caused a limp, and at times precluded the patient from performing tumbling maneuvers in cheerleading practice. On physical examination, there was no ecchymosis, edema, or asymmetry compared with the contralateral heel. Medial and lateral heel compression where the calcaneal apophysis attaches to the main body of the calcaneus reproduced the patient's pain, suggesting Sever disease, or calcaneal apophysitis. Radiographs were ordered to ensure that no traumatic injury occurred and revealed a nonfractured bipartite right posterior calcaneal apophysis with increased sclerotic density (image, arrow). The inflammation of Sever disease is self-limiting, and the patient healed over time with increased rest. 
Although Sever disease affects individuals differently, researchers have found that children with this disease experience a decrease in quality of life.1 Diagnosis can often be made with clinical findings alone,2 but further evaluation with radiography is advised as a more malignant finding could be overlooked.3 
   Financial Disclosures: None reported.
   Support: None reported.
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Kose O. Do we really need radiographic assessment for the diagnosis of non-specific heel pain (calcaneal apophysitis) in children? Skeletal Radiol. 2010;39(4):359-361. doi:10.1007/s00256-009-0774-y. [CrossRef] [PubMed]
Rachel JN, Williams JB, Sawyer JR, Warner WC, Kelly DM. Is radiographic evaluation necessary in children with a clinical diagnosis of calcaneal apophysitis (sever disease)? J Pediatr Orthop. 2011;31(5):548-550. doi:10.1097/BPO.0b013e318219905c. [CrossRef] [PubMed]