Classic history and presentation: Typical symptoms include pain in the area of the calcaneal apophysis that increases with activity and impact. There may also be mild swelling present at the posterior heel. Patients typically describe an insidious onset without any specific injury. There is a bilateral incidence of approximately 60%.
- Age – The mean age of presentation is from 8-12 years, or approximately at the onset of puberty, around the time of a growth spurt.
- Sex / gender – Boys are more commonly affected than girls with a ratio of 2-3:1.
Pathophysiology: Growth plates are areas of relative weakness compared to the nearby tendons and ligaments. By definition, as a type of apophysitis, calcaneal apophysitis only occurs in pediatric or adolescent patients in whom the growth plate has not yet closed, and it typically occurs during a narrow range of skeletal maturity.
M92.8 – Other specified juvenile osteochondrosis
23890000 – Calcaneal apophysitis
- Heel contusion / painful heel pad – Pain localized to heel pad.
- Plantar fasciitis – Less common in children. Pain typically presents in the morning, whereas calcaneal apophysitis patients are typically asymptomatic in the morning.
- Achilles tendonitis – Typically, pain is in the distal Achilles tendon; more common in adults.
- Calcaneal stress fracture – May differentiate with MRI. See calcaneal fracture.
- Retrocalcaneal bursitis