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Calcaneal apophysitis
Other Resources UpToDate PubMed

Calcaneal apophysitis

Contributors: Stephanie MacDonald DO, Katie Rizzone MD, MPH
Other Resources UpToDate PubMed


Causes / typical injury mechanism: Calcaneal apophysitis, also known as Sever's disease, is a traumatic overuse injury in which the growth plate of the calcaneus becomes inflamed as a result of repetitive stress to the heel. The etiology is thought to be the result of microtraumas from repetitive traction at the site of the Achilles tendon attachment, impact pressure, and shear forces from activity. It is the most common cause of heel pain in growing children.

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.
Risk factors: Calcaneal apophysitis is commonly seen in athletes who participate in sports that involve repetitive running and jumping such as soccer, gymnastics, and basketball. Patients may present with this condition shortly after the start of a new sport or season. Other general risk factors include patients who participate in year-round sports, wear poorly fitting footwear, or have foot deformities such as pes cavus, pes planus, or poor heel cord flexibility.

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

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Differential Diagnosis & Pitfalls

  • 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

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Last Reviewed:07/20/2021
Last Updated:07/20/2021
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Calcaneal apophysitis
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