Sever Disease Workup
- Author: Mark A Noffsinger, MD; Chief Editor: Jason H Calhoun, MD, FACS more...
Radiographic findings include increased sclerosis and fragmentation of the calcaneal apophysis. However, it should be stressed that these findings are nonspecific and also are observed in asymptomatic feet (see the image below). Radiographic evaluation is beneficial for excluding fracture or rare tumor. It is vital to remember that radiographic changes on plain x-ray films are neither diagnostic nor prognostic; their primary value in this setting is for exclusion of other causes of heel pain. This point should be clearly explained to patients and parents.
It must be kept in mind that if pain continues, becomes significant at rest, awakens the patient from sleep, or is associated with significant swelling, tests should be performed to look for other causes. Tarsal coalition is another hindfoot disorder that must be distinguished from Sever disease. Thus, if reduction of subtalar motion is found on physical examination, computed tomography (CT) can be helpful in differentiating this disease from failure of the bones of the hindfoot to separate.
In cases of high suspicion, magnetic resonance imaging (MRI) may be of use for ruling out osteomyelitis, as seen in the image below.
Sever disease is characterized by disorder of the normal process of enchondral ossification.
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