9 years old male patient, with chief complain of pain in both
heels, which worsen by physical activities such as walking, running.
Physical examination: generally normal, Squeeze test (+) on
right side.
On ultrasound plantar fascia is normal. Note: the anechoic region between calcaneous is not fluid (which can indirectly suggest fascilitis in case of adult) but in fact the normal apophysis (growth plate).
Achilles tendon is normal and remains continous fibrous echotexture (US 2), again, the rough bone surface with anechoic shown normal apophysis.
Normal distance to apophysis in both sides, no dislocation, no avulsion.
X-rays examination of both 2 heel are normal.
Physician suggests Sever's disease, and patient was told to take some time to
rest, proper physical activity and shoes fitting.
rest, proper physical activity and shoes fitting.
Conclusion:
Sever's disease, the most common cause of children heel
pain, known as calcaneal apophysitis is an inflammation of growth plate in heel
of growing children. Diagnosis usually
bases on clinical, and X-rays is normal. Ultrasound is suitable diagnostic tool
while X-ray examination is only helpful when an ossification center of apophysis
exist. Ultrasound helps ruling out muscle strain, detect edema, lytic and avulsion.
